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Fox AJ, Matthews N, Qiu Z, Filmer HL, Dux PE. On the lasting impact of mild traumatic brain injury on working memory: Behavioural and electrophysiological evidence. Neuropsychologia 2024:109005. [PMID: 39313130 DOI: 10.1016/j.neuropsychologia.2024.109005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 08/06/2024] [Accepted: 09/20/2024] [Indexed: 09/25/2024]
Abstract
Despite increasing recognition of the significance of mild traumatic brain injury (mTBI), the long-term cognitive consequences of the injury remain unclear. More sensitive measures that can detect subtle cognitive changes and consideration of individual variability are needed to properly characterise cognitive outcomes following mTBI. Here, we used complex behavioural tasks, individual differences approaches, and electrophysiology to investigate the long-term cognitive effects of a history of mTBI. In Experiment 1, participants with self-reported mTBI history (n=82) showed poorer verbal working memory performance on the operation span task compared to control participants (n=88), but there were no group differences in visual working memory, multitasking, cognitive flexibility, attentional control, visuospatial ability, or information processing speed. Individual differences analyses revealed that time since injury and presence of memory loss predicted visual working memory capacity and visuospatial ability, respectively, in those with mTBI history. In Experiment 2, participants with mTBI history (n=20) again demonstrated poorer verbal working memory on the operation span task compared to control participants (n=38), but no group differences were revealed on a visuospatial complex span task or simpler visual working memory measures. We also explored the electrophysiological indices of visual working memory using EEG during a change detection task. No differences were observed in early sensory event-related potentials (P1, N1) or the later negative slow wave associated with visual working memory capacity. Together, these findings suggest that mTBI history may be associated with a lasting, isolated disruption in the subsystem underlying verbal working memory storage. The results emphasize the importance of sensitive cognitive measures and accounting for individual variability in injury characteristics when assessing mTBI outcomes.
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Affiliation(s)
- Amaya J Fox
- School of Psychology, The University of Queensland, St Lucia, Australia.
| | - Natasha Matthews
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Zeguo Qiu
- Max Planck Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
| | - Hannah L Filmer
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Paul E Dux
- School of Psychology, The University of Queensland, St Lucia, Australia
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2
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Laskowitz S, Baird CL, Huggins A, Nadareishvili N, Bride J, Wagner HR, Briggs M, Morey RA, Turner RW. Effects of mTBI with loss of consciousness on neurobehavioral symptoms, depression, and insomnia in former collegiate and NFL football athletes. Brain Inj 2024; 38:869-879. [PMID: 38727539 PMCID: PMC11323146 DOI: 10.1080/02699052.2024.2347552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Considering that diagnostic decisions about mTBI are often predicated on clinical symptom criteria, it is imperative to determine which initial presentation features of mTBI have prognostic significance for identifying those at high risk for long-term functional impairment. SETTING Zoom interview Participants: Male, former NCAA Division I, and professional-level National Football League (NFL) athletes (n = 177) between the ages of 27 and 85 (M = 54.1, SD = 14.7). DESIGN Cross-sectional case-control. Main Measures: History of mild TBI, history of loss of consciousness (LOC), depression symptoms, insomnia, neurobehavioral symptoms. RESULTS Number of mTBI exposures did not predict neurobehavioral symptoms (B = 0.21, SE = 0.18, p = 0.23), but number of mTBI + LOC events did (B = 2.27, SE = 0.64, p = <.001). Further analysis revealed that the number of mTBI + LOC events predicted neurobehavioral symptoms indirectly through both depression (B = 0.85, 95% CI = [0.27, 1.52) and insomnia (B = 0.81, 95% CI = [0.3, 1.4]). Further, the direct effect of mTBI + LOC events on neurobehavioral symptoms became non-significant when depression and insomnia were added to the model (B = 0.78, SE = 0.45, p = 0.08). CONCLUSIONS Findings support LOC at time of injury as an important predictor of long-term outcomes. Additionally, results suggest depression and insomnia as potential mediators in the association between mTBI + LOC and neurobehavioral symptoms. These findings provide justification for early depression and insomnia symptom monitoring following mTBI + LOC.
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Affiliation(s)
- Sarah Laskowitz
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina, USA
| | - C Lexi Baird
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Ashley Huggins
- Department of Psychology, The University of Arizona, Tucson, Arizona, USA
| | - Nino Nadareishvili
- School of Medicine and Health Sciences, Department of Clinical Research and Leadership, George Washington University, Washington, District of Columbia, USA
| | - Jessica Bride
- School of Medicine and Health Sciences, Department of Clinical Research and Leadership, George Washington University, Washington, District of Columbia, USA
| | - H Ryan Wagner
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Melvin Briggs
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Rajendra A Morey
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert W Turner
- Department of Clinical Research & Leadership, School of Medicine & Health Sciences, The George Washington University, Washington, USA
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3
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Knapp CP, Papadopoulos E, Loweth JA, Raghupathi R, Floresco SB, Waterhouse BD, Navarra RL. Sex-dependent perturbations in risky choice behavior and prefrontal tyrosine hydroxylase levels induced by repetitive mild traumatic brain injury. Behav Brain Res 2024; 476:115244. [PMID: 39241835 DOI: 10.1016/j.bbr.2024.115244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/30/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
Head trauma often impairs cognitive processes mediated within the prefrontal cortex (PFC), leading to impaired decision making and risk-taking behavior. Mild traumatic brain injury (mTBI) accounts for approximately 80 % of reported head injury cases. Most neurological symptoms of a single mTBI are transient; however, growing evidence suggests that repeated mTBI (rmTBI) results in more severe impairments that worsen with each subsequent injury. Although mTBI-induced disruption of risk/reward decision making has been characterized, the potential for rmTBI to exacerbate these effects and the neural mechanisms involved are unknown. Catecholamine neurotransmitters, dopamine (DA) and norepinephrine (NE), modulate PFC-mediated functions. Imbalances in catecholamine function have been associated with TBI and may underlie aberrant decision making. We used a closed head-controlled cortical impact (CH-CCI) model in rats to evaluate the effects of rmTBI on performance of a probabilistic discounting task of risk/reward decision making behavior and expression levels of catecholamine regulatory proteins within the PFC. RmTBI produced transient increases in risky choice preference in both male and female rats, with these effects persisting longer in females. Additionally, rmTBI increased expression of the catecholamine synthetic enzyme, tyrosine hydroxylase (TH), within the orbitofrontal (OFC) region of the PFC in females only. These results suggest females are more susceptible to rmTBI-induced disruption of risk/reward decision making behavior and dysregulation of catecholamine synthesis within the OFC. Together, using the CH-CCI model of rodent rmTBI to evaluate the effects of multiple insults on risk-taking behavior and PFC catecholamine regulation begins to differentiate how mTBI occurrences affect neuropathological outcomes across different sexes.
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Affiliation(s)
- Christopher P Knapp
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
| | - Eleni Papadopoulos
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
| | - Jessica A Loweth
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 W. Queen Lane, Philadelphia, PA 19129, USA.
| | - Stan B Floresco
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2136 West Mall, Vancouver, BC V6T 1Z4, Canada.
| | - Barry D Waterhouse
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
| | - Rachel L Navarra
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, 42 East Laurel Road, Suite 2200, Stratford, NJ 08084, USA.
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4
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Cox AW, Fernandes MA. Long-term cognitive and affective consequences of mild traumatic brain injury: comparison with older adults. Brain Inj 2024:1-14. [PMID: 38994705 DOI: 10.1080/02699052.2024.2376769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE Memory and affective processing were compared in young adults with a remote mild traumatic brain injury (mTBI), to healthy younger and older adults. We evaluated memory performance when encoding was done under multi-tasking (divided attention) conditions, likely to exacerbate cognitive and psychological symptoms in mTBI. METHODS Participants studied pairs of unrelated words under either full or divided attention conditions. Memory for single words (item memory) and for pairs of words (associative memory) was then assessed in sequential independent recognition tests, under full attention. RESULTS Associative memory was poorer than item memory, and worse when encoding was done under divided than full attention. The decline in recognition accuracy from full to divided attention conditions on the associative memory test was significantly greater in mTBI compared to young adults and was similar in magnitude to that observed in older adults under full attention. Self-reported mental and total fatigue increased significantly as performance on the memory tests, following the divided attention condition, decreased, but only in the mTBI group. CONCLUSIONS Results show lingering memory deficits, and suggest that cognitive tasks may be experienced as psychologically more demanding in those with a mTBI, even months or years after injury.
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Affiliation(s)
- Adam William Cox
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Myra A Fernandes
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
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Rahmani F, Batson RD, Zimmerman A, Reddigari S, Bigler ED, Lanning SC, Ilasa E, Grafman JH, Lu H, Lin AP, Raji CA. Rate of abnormalities in quantitative MR neuroimaging of persons with chronic traumatic brain injury. BMC Neurol 2024; 24:235. [PMID: 38969967 PMCID: PMC11225195 DOI: 10.1186/s12883-024-03745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) can result in lasting brain damage that is often too subtle to detect by qualitative visual inspection on conventional MR imaging. Although a number of FDA-cleared MR neuroimaging tools have demonstrated changes associated with mTBI, they are still under-utilized in clinical practice. METHODS We investigated a group of 65 individuals with predominantly mTBI (60 mTBI, 48 due to motor-vehicle collision, mean age 47 ± 13 years, 27 men and 38 women) with MR neuroimaging performed in a median of 37 months post-injury. We evaluated abnormalities in brain volumetry including analysis of left-right asymmetry by quantitative volumetric analysis, cerebral perfusion by pseudo-continuous arterial spin labeling (PCASL), white matter microstructure by diffusion tensor imaging (DTI), and neurometabolites via magnetic resonance spectroscopy (MRS). RESULTS All participants demonstrated atrophy in at least one lobar structure or increased lateral ventricular volume. The globus pallidi and cerebellar grey matter were most likely to demonstrate atrophy and asymmetry. Perfusion imaging revealed significant reductions of cerebral blood flow in both occipital and right frontoparietal regions. Diffusion abnormalities were relatively less common though a subset analysis of participants with higher resolution DTI demonstrated additional abnormalities. All participants showed abnormal levels on at least one brain metabolite, most commonly in choline and N-acetylaspartate. CONCLUSION We demonstrate the presence of coup-contrecoup perfusion injury patterns, widespread atrophy, regional brain volume asymmetry, and metabolic aberrations as sensitive markers of chronic mTBI sequelae. Our findings expand the historic focus on quantitative imaging of mTBI with DTI by highlighting the complementary importance of volumetry, arterial spin labeling perfusion and magnetic resonance spectroscopy neurometabolite analyses in the evaluation of chronic mTBI.
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Affiliation(s)
- Farzaneh Rahmani
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Richard D Batson
- Endocrine & Brain Injury Research Alliance, Neurevolution Medicine, PLLC, NUNM Helfgott Research Institute, Portland, Oregon, USA
| | | | | | - Erin D Bigler
- Department of Neurology, Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | | | | | - Jordan H Grafman
- Departments of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine, Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander P Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Cyrus A Raji
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, USA.
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Knapp CP, Papadopoulos E, Loweth JA, Raghupathi R, Floresco SB, Waterhouse BD, Navarra RL. Perturbations in risk/reward decision making and frontal cortical catecholamine regulation induced by mild traumatic brain injury. Behav Brain Res 2024; 467:115002. [PMID: 38636779 DOI: 10.1016/j.bbr.2024.115002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
Mild traumatic brain injury (mTBI) disrupts cognitive processes that influence risk taking behavior. Little is known regarding the effects of repetitive mild injury (rmTBI) or whether these outcomes are sex specific. Risk/reward decision making is mediated by the prefrontal cortex (PFC), which is densely innervated by catecholaminergic fibers. Aberrant PFC catecholamine activity has been documented following TBI and may underlie TBI-induced risky behavior. The present study characterized the effects of rmTBI on risk/reward decision making behavior and catecholamine transmitter regulatory proteins within the PFC. Rats were exposed to sham, single (smTBI), or three closed-head controlled cortical impact (CH-CCI) injuries and assessed for injury-induced effects on risk/reward decision making using a probabilistic discounting task (PDT). In the first week post-final surgery, mTBI increased risky choice preference. By the fourth week, males exhibited increased latencies to make risky choices following rmTBI, demonstrating a delayed effect on processing speed. When levels of tyrosine hydroxylase (TH) and the norepinephrine reuptake transporter (NET) were measured within subregions of the PFC, females exhibited dramatic increases of TH levels within the orbitofrontal cortex (OFC) following smTBI. However, both males and females demonstrated reduced levels of OFC NET following rmTBI. These results indicate the OFC is susceptible to catecholamine instability after rmTBI and suggests that not all areas of the PFC contribute equally to TBI-induced imbalances. Overall, the CH-CCI model of rmTBI has revealed time-dependent and sex-specific changes in risk/reward decision making and catecholamine regulation following repetitive mild head injuries.
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Affiliation(s)
- Christopher P Knapp
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA.
| | - Eleni Papadopoulos
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Jessica A Loweth
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Stan B Floresco
- Department of Psychology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Barry D Waterhouse
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA
| | - Rachel L Navarra
- Department of Cell Biology and Neuroscience, Rowan-Virtua School of Translational Biomedical Engineering and Sciences, Stratford, NJ, USA.
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7
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Markicevic M, Mandino F, Toyonaga T, Cai Z, Fesharaki-Zadeh A, Shen X, Strittmatter SM, Lake E. Repetitive mild closed-head injury induced synapse loss and increased local BOLD-fMRI signal homogeneity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.24.595651. [PMID: 38826468 PMCID: PMC11142233 DOI: 10.1101/2024.05.24.595651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Repeated mild head injuries due to sports, or domestic violence and military service are increasingly linked to debilitating symptoms in the long term. Although symptoms may take decades to manifest, potentially treatable neurobiological alterations must begin shortly after injury. Better means to diagnose and treat traumatic brain injuries, requires an improved understanding of the mechanisms underlying progression and means through which they can be measured. Here, we employ a repetitive mild closed-head injury (rmTBI) and chronic variable stress (CVS) mouse model to investigate emergent structural and functional brain abnormalities. Brain imaging is achieved with [ 18 F]SynVesT-1 positron emission tomography, with the synaptic vesicle glycoprotein 2A ligand marking synapse density and BOLD (blood-oxygen-level-dependent) functional magnetic resonance imaging (fMRI). Animals were scanned six weeks after concluding rmTBI/Stress procedures. Injured mice showed widespread decreases in synaptic density coupled with an i ncrease in local BOLD-fMRI synchrony detected as regional homogeneity. Injury-affected regions with higher synapse density showed a greater increase in fMRI regional homogeneity. Taken together, these observations may reflect compensatory mechanisms following injury. Multimodal studies are needed to provide deeper insights into these observations.
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8
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Sullivan D, Vaglio BJ, Cararo-Lopes MM, Wong RDP, Graudejus O, Firestein BL. Stretch-Induced Injury Affects Cortical Neuronal Networks in a Time- and Severity-Dependent Manner. Ann Biomed Eng 2024; 52:1021-1038. [PMID: 38294641 DOI: 10.1007/s10439-023-03438-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024]
Abstract
Traumatic brain injury (TBI) is the leading cause of accident-related death and disability in the world and can lead to long-term neuropsychiatric symptoms, such as a decline in cognitive function and neurodegeneration. TBI includes primary and secondary injury, with head trauma and deformation of the brain caused by the physical force of the impact as primary injury, and cellular and molecular cascades that lead to cell death as secondary injury. Currently, there is no treatment for TBI-induced cell damage and neural circuit dysfunction in the brain, and thus, it is important to understand the underlying cellular mechanisms that lead to cell damage. In the current study, we use stretchable microelectrode arrays (sMEAs) to model the primary injury of TBI to study the electrophysiological effects of physically injuring cortical cells. We recorded electrophysiological activity before injury and then stretched the flexible membrane of the sMEAs to injure the cells to varying degrees. At 1, 24, and 72 h post-stretch, we recorded activity to analyze differences in spike rate, Fano factor, burstlet rate, burstlet width, synchrony of firing, local network efficiency, and Q statistic. Our results demonstrate that mechanical injury changes the firing properties of cortical neuron networks in culture in a time- and severity-dependent manner. Our results suggest that changes to electrophysiological properties after stretch are dependent on the strength of synchronization between neurons prior to injury.
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Affiliation(s)
- Dylan Sullivan
- Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Cell and Developmental Biology Graduate Program, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Brandon J Vaglio
- Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Biomedical Engineering Graduate Program, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Marina M Cararo-Lopes
- Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Cell and Developmental Biology Graduate Program, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Ruben D Ponce Wong
- BioMedical Sustainable Elastic Electronic Devices (BMSEED), Mesa, AZ, USA
| | - Oliver Graudejus
- BioMedical Sustainable Elastic Electronic Devices (BMSEED), Mesa, AZ, USA
- School of Molecular Science, Arizona State University, Tempe, AZ, USA
| | - Bonnie L Firestein
- Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
- Department of Cell Biology and Neuroscience, Rutgers University, 604 Allison Road, Piscataway, NJ, 08854-8082, USA.
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van Rhijn S, Teixeira-Dias M, Medford N, Nicholson T, Okai D, Shotbolt P, Deeley Q. Predictive Utility of Diffusion MRI After Mild Traumatic Brain Injury in Civilian Populations: A Systematic Review. J Neuropsychiatry Clin Neurosci 2024; 36:187-196. [PMID: 38528807 DOI: 10.1176/appi.neuropsych.20230122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
OBJECTIVE A considerable number of people experience persisting symptoms and functional limitations after mild traumatic brain injury (mTBI). It is unclear whether subtle white matter changes contribute to this phenomenon. In this systematic review, the authors evaluated whether microstructural white matter indices on advanced MRI are related to clinical dysfunction among patients without abnormalities on standard brain computed tomography (CT) or MRI (uncomplicated mTBI). METHODS A search of multiple databases was performed. Studies with individuals who experienced blast-related, sports-related, or multiple mTBIs were excluded. Diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) metrics and cognitive, neuropsychiatric, or functional outcome measures were extracted from each study. RESULTS Thirteen studies were selected (participants with mTBI, N=553; healthy control group, N=438). Seven DTI studies evaluated cognitive function, with five reporting significant correlations between reduced white matter integrity and deficits in attention, processing speed, and executive function at 6-12 months after injury (three studies included only individuals with uncomplicated mTBI). Four studies found significant correlations between DTI metrics and persistent postconcussive symptoms after 3-12 months (one study included only individuals with uncomplicated mTBI). Two SWI studies reported conflicting findings regarding the relationship between the presence of microbleeds and postconcussive symptoms. CONCLUSIONS The results revealed that indices of microstructural white matter integrity may relate to clinical presentation 3-12 months after injury in uncomplicated mTBI. However, analysis methods and brain regions studied varied across studies. Further research is needed to identify relationships between white matter indices in specific brain regions and symptom persistence beyond 12 months.
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Affiliation(s)
- Sanne van Rhijn
- Department of Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (all authors); Perinatal Mental Health Service, West London National Health Service Trust, London (van Rhijn)
| | - Maria Teixeira-Dias
- Department of Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (all authors); Perinatal Mental Health Service, West London National Health Service Trust, London (van Rhijn)
| | - Nick Medford
- Department of Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (all authors); Perinatal Mental Health Service, West London National Health Service Trust, London (van Rhijn)
| | - Timothy Nicholson
- Department of Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (all authors); Perinatal Mental Health Service, West London National Health Service Trust, London (van Rhijn)
| | - David Okai
- Department of Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (all authors); Perinatal Mental Health Service, West London National Health Service Trust, London (van Rhijn)
| | - Paul Shotbolt
- Department of Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (all authors); Perinatal Mental Health Service, West London National Health Service Trust, London (van Rhijn)
| | - Quinton Deeley
- Department of Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (all authors); Perinatal Mental Health Service, West London National Health Service Trust, London (van Rhijn)
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10
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Neumann KD, Broshek DK, Newman BT, Druzgal TJ, Kundu BK, Resch JE. Concussion: Beyond the Cascade. Cells 2023; 12:2128. [PMID: 37681861 PMCID: PMC10487087 DOI: 10.3390/cells12172128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
Sport concussion affects millions of athletes each year at all levels of sport. Increasing evidence demonstrates clinical and physiological recovery are becoming more divergent definitions, as evidenced by several studies examining blood-based biomarkers of inflammation and imaging studies of the central nervous system (CNS). Recent studies have shown elevated microglial activation in the CNS in active and retired American football players, as well as in active collegiate athletes who were diagnosed with a concussion and returned to sport. These data are supportive of discordance in clinical symptomology and the inflammatory response in the CNS upon symptom resolution. In this review, we will summarize recent advances in the understanding of the inflammatory response associated with sport concussion and broader mild traumatic brain injury, as well as provide an outlook for important research questions to better align clinical and physiological recovery.
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Affiliation(s)
- Kiel D. Neumann
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN 38105, USA;
| | - Donna K. Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22903, USA;
| | - Benjamin T. Newman
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA; (B.T.N.); (T.J.D.); (B.K.K.)
| | - T. Jason Druzgal
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA; (B.T.N.); (T.J.D.); (B.K.K.)
| | - Bijoy K. Kundu
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA 22903, USA; (B.T.N.); (T.J.D.); (B.K.K.)
| | - Jacob E. Resch
- Department of Kinesiology, University of Virginia, Charlottesville, VA 22903, USA
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11
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Giudice JS, Druzgal TJ, Panzer MB. Investigating the Effect of Brain Size on Deformation Magnitude Using Subject-Specific Finite Element Models. J Neurotrauma 2023; 40:1796-1807. [PMID: 37002891 DOI: 10.1089/neu.2022.0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Abstract In the last decade, computational models of the brain have become the gold standard tool for investigating traumatic brain injury (TBI) mechanisms and developing novel protective equipment and other safety countermeasures. However, most studies utilizing finite element (FE) models of the brain have been conducted using models developed to represent the average neuroanatomy of a target demographic, such as the 50th percentile male. Although this is an efficient strategy, it neglects normal anatomical variations present within the population and their contributions on the brain's deformation response. As a result, the contributions of structural characteristics of the brain, such as brain volume, on brain deformation are not well understood. The objective of this study was to develop a set of statistical regression models relating measures of the size and shape of the brain to the resulting brain deformation. This was performed using a database of 125 subject-specific models, simulated under six independent head kinematic boundary conditions, spanning a range of impact modes (frontal, oblique, side), severity (non-injurious and injurious), and environments (volunteer, automotive, and American football). Two statistical regression techniques were utilized. First, simple linear regression (SLR) models were trained to relate intracranial volume (ICV) and the 95th percentile of maximum principal strain (MPS-95) for each of the impact cases. Second, a partial least squares regression model was constructed to predict MPS-95 based on the affine transformation parameters from each subject, representing the size and shape of their brain, considering the six impact conditions collectively. Both techniques indicated a strong linear relationship between ICV and MPS-95, with MPS-95 varying by approximately 5% between the smallest and largest brains. This difference represented up to 40% of the mean strain across all subjects. This study represents a comprehensive assessment of the relationships between brain anatomy and deformation, which is crucial for the development of personalized protective equipment, identifying individuals at higher risk of injury, and using computational models to aid clinical diagnostics of TBI.
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Affiliation(s)
- J Sebastian Giudice
- Center for Applied Biomechanics, Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - T Jason Druzgal
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Matthew B Panzer
- Center for Applied Biomechanics, Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, Virginia, USA
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Churchill NW, Graham SJ, Schweizer TA. Perfusion Imaging of Traumatic Brain Injury. Neuroimaging Clin N Am 2023; 33:315-324. [PMID: 36965948 DOI: 10.1016/j.nic.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
The mechanisms for regulating cerebral blood flow (CBF) are highly sensitive to traumatic brain injury (TBI). The perfusion imaging technique may be used to assess CBF and identify perfusion abnormalities following a TBI. Studies have identified CBF disturbances across the injury severity spectrum and correlations with both acute and long-term indices of clinical outcome. Although not yet widely used in the clinical context, this is an important area of ongoing research.
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Affiliation(s)
- Nathan W Churchill
- Neuroscience Research Program, Saint Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Physics Department, Toronto Metropolitan University, 60 St George St, Toronto, ON M5S 1A7, Canada.
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, 101 College Street, Suite 15-701, Toronto, ON M5G 1L7, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Wellness Way, Toronto, ON M4N 3M5, Canada; Physical Sciences Platform, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - Tom A Schweizer
- Neuroscience Research Program, Saint Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, 209 Victoria Street, Toronto, ON M5B 1M8, Canada; Faculty of Medicine (Neurosurgery), University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
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Diffusion-Weighted Imaging in Mild Traumatic Brain Injury: A Systematic Review of the Literature. Neuropsychol Rev 2023; 33:42-121. [PMID: 33721207 DOI: 10.1007/s11065-021-09485-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
There is evidence that diffusion-weighted imaging (DWI) is able to detect tissue alterations following mild traumatic brain injury (mTBI) that may not be observed on conventional neuroimaging; however, findings are often inconsistent between studies. This systematic review assesses patterns of differences in DWI metrics between those with and without a history of mTBI. A PubMed literature search was performed using relevant indexing terms for articles published prior to May 14, 2020. Findings were limited to human studies using DWI in mTBI. Articles were excluded if they were not full-length, did not contain original data, if they were case studies, pertained to military populations, had inadequate injury severity classification, or did not report post-injury interval. Findings were reported independently for four subgroups: acute/subacute pediatric mTBI, acute/subacute adult mTBI, chronic adult mTBI, and sport-related concussion, and all DWI acquisition and analysis methods used were included. Patterns of findings between studies were reported, along with strengths and weaknesses of the current state of the literature. Although heterogeneity of sample characteristics and study methods limited the consistency of findings, alterations in DWI metrics were most commonly reported in the corpus callosum, corona radiata, internal capsule, and long association pathways. Many acute/subacute pediatric studies reported higher FA and lower ADC or MD in various regions. In contrast, acute/subacute adult studies most commonly indicate lower FA within the context of higher MD and RD. In the chronic phase of recovery, FA may remain low, possibly indicating overall demyelination or Wallerian degeneration over time. Longitudinal studies, though limited, generally indicate at least a partial normalization of DWI metrics over time, which is often associated with functional improvement. We conclude that DWI is able to detect structural mTBI-related abnormalities that may persist over time, although future DWI research will benefit from larger samples, improved data analysis methods, standardized reporting, and increasing transparency.
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14
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Detection of Walking Features Using Mobile Health and Deep Learning. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study identifies seven human subjects’ walking features by training a deep learning model with sensor data. Using the proposed Mobile Health Application developed for collecting sensor data from an Android device, we collected data from human subjects with a history of mild traumatic brain injury. The sensors measure acceleration in m/s2 with respect to: the X, Y, and Z directions using an accelerometer, the rate of rotation around a spatial axis with a gyroscope, and nine parameters of a rotation vector with rotation vector components along the X, Y, Z axes using a rotation vector software-based sensor. We made a deep learning model using Tensorflow and Keras to identify the walking features of the seven subjects. The data are classified into the following categories: Accelerometer (X, Y, Z); Gyroscope (X, Y, Z); Rotation (X, Y, Z); Rotation vector (nine parameters); and a combination of the preceding categories. Each dataset was then used for training and testing the accuracy of the deep learning model. According to the Keras evaluation function, the deep learning model trained with Rotation vector data shows 99.5% accuracy for classifying walking characteristics of subjects. In addition, the ability of the model to accurately classify the characteristics of subjects’ walking with all datasets combined is 99.9%.
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Bullard LE, Coffman CA, Kay JJM, Holloway JP, Moore RD, Pontifex MB. Attention-Deficit/Hyperactivity Disorder-Related Self-Reported Symptoms Are Associated With Elevated Concussion Symptomatology. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2022; 44:116-126. [PMID: 35213818 DOI: 10.1123/jsep.2021-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
The aim of the present investigation was to provide insight into how postconcussion symptomatology may be altered in individuals exhibiting attention-deficit/hyperactivity disorder (ADHD)-related behaviors and examine factors that may be responsible for driving such relationships. A total of 99 individuals were assessed during the subacute phase of concussion recovery. Inattentive symptomatology, but not diagnosis of ADHD, was related to greater concussion-symptom severity and overall symptoms endorsed. Cluster and factor analyses highlighted that the relationship between ADHD symptomatology and concussion symptomatology was not a function of overlapping constructs being assessed (i.e., concussion-related symptomatology was not a proxy of ADHD-related symptomatology). These relationships were not mediated by parental observations of impairments in behaviors associated with executive functioning (i.e., executive dysfunction was not driving the greater concussion-related symptomatology associated with ADHD-related symptomatology). These findings highlight the importance of moving beyond categorical frameworks of ADHD to, instead, consider the continuum of underlying behaviors.
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Affiliation(s)
- Lauren E Bullard
- Department of Kinesiology, Michigan State University, East Lansing, MI,USA
| | - Colt A Coffman
- Department of Kinesiology, Michigan State University, East Lansing, MI,USA
| | - Jacob J M Kay
- Pediatric Concussion Clinic, Prisma Health Children's Hospital-Midlands, Columbia, SC,USA
| | - Jeffrey P Holloway
- Pediatric Concussion Clinic, Prisma Health Children's Hospital-Midlands, Columbia, SC,USA
| | - Robert D Moore
- Department of Exercise Science, University of South Carolina, Columbia, SC,USA
| | - Matthew B Pontifex
- Department of Kinesiology, Michigan State University, East Lansing, MI,USA
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Myers JR, Solomon NP, Lange RT, French LM, Lippa SM, Brickell TA, Staines S, Nelson J, Brungart DS, Coelho CA. Analysis of Discourse Production to Assess Cognitive Communication Deficits Following Mild Traumatic Brain Injury With and Without Posttraumatic Stress. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:84-98. [PMID: 34932411 DOI: 10.1044/2021_ajslp-20-00281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Cognitive communication deficits can be difficult to assess in individuals with mild traumatic brain injury (mTBI). However, the use of discourse analysis as a direct and sensitive metric of cognitive communication skills has shown promising clinical utility for other TBI severity levels. This exploratory study investigated discourse production in service members and veterans (SMVs) with uncomplicated mTBI with and without posttraumatic stress disorder (PTSD) and SMVs with neither mTBI or PTSD. METHOD Fifteen SMVs with mTBI and PTSD, 26 with mTBI, and 25 controls with no brain injury (NBI) and without PTSD were given a wordless picture story to elicit spontaneous discourse. Discourse samples were analyzed for global coherence, word count, the use of negative emotion words, cognitive process words, nonfluencies, and story completeness. RESULTS Results revealed a significant difference between the mTBI (Mdn = 3.33) and NBI (Mdn = 3.50) groups, χ2(3) = 6.044, p = .017, ε2 = .03, for global coherence. Word count differed significantly between the mTBI + PTSD (Mdn = 135) and NBI (Mdn = 195) groups, χ2(3) = 7.968, p = .006, ε2 = .06. No other group differences were observed. DISCUSSION Structural features of discourse production may serve as potential markers of cognitive communication deficits in mTBI. Furthermore, PTSD may contribute to verbal fluency deficits in individuals with mTBI. Additional research is needed to develop discourse-related measures that are more sensitive to the effects of mTBI and PTSD.
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Affiliation(s)
- Jennifer Rae Myers
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
| | - Nancy Pearl Solomon
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- University of British Columbia, Vancouver, British Columbia, Canada
- General Dynamics Information Technology, Falls Church, VA
- Center of Excellence on Post-Traumatic Stress Disorder, Ottawa, Ontario, Canada
| | - Louis M French
- Uniformed Services University of the Health Sciences, Bethesda, MD
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Tracey A Brickell
- Uniformed Services University of the Health Sciences, Bethesda, MD
- Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
- General Dynamics Information Technology, Falls Church, VA
- Center of Excellence on Post-Traumatic Stress Disorder, Ottawa, Ontario, Canada
| | | | | | - Doug S Brungart
- National Military Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD
- Uniformed Services University of the Health Sciences, Bethesda, MD
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17
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Silverberg ND, Cairncross M, Brasher PMA, Vranceanu AM, Snell DL, Yeates KO, Panenka WJ, Iverson GL, Debert CT, Bayley MT, Hunt C, Baker A, Burke MJ. Feasibility of concussion rehabilitation approaches tailored to psychological coping styles: A randomized controlled trial. Arch Phys Med Rehabil 2021; 103:1565-1573.e2. [PMID: 34971596 DOI: 10.1016/j.apmr.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a clinical trial involving participants with concussion randomized to treatments designed to address fear avoidance or endurance coping, which are risk factors for disability. A secondary objective was to evaluate whether each treatment could effect selective change on targeted coping outcomes. DESIGN Randomized controlled trial. SETTING Outpatient concussion clinics. PARTICIPANTS 73 adults (M=42.5 years old) who had persistent post-concussion symptoms and high avoidance or endurance behavior were enrolled at M=12.9 weeks post injury. 10 participants did not complete treatment. INTERVENTIONS Participants were randomized to an interdisciplinary rehabilitation program delivered via videoconferencing and tailored to avoidance coping (graded exposure therapy; GET) or endurance coping (operant condition-based pacing strategies plus mindfulness training; Pacing+). MAIN OUTCOME MEASURES Feasibility outcomes included screening efficiency, accrual, credibility, treatment fidelity, adherence, and retention. Avoidance was measured with the Fear Avoidance Behavior after Traumatic Brain Injury questionnaire and endurance behavior with the Behavioral Response to Illness Questionnaire. RESULTS Screening efficiency, or the proportion of clinic patients who were assessed for eligibility, was 44.5% (275/618). 65.8% (73/111) of eligible patients were randomized (n=37 to GET and n=36 to Pacing+), meeting accrual targets. 91.7% (55/60) of participants perceived treatment as credible. Therapists covered M=96.8% of essential prescribed elements, indicating excellent fidelity. The majority (71.2%; 47/66) of participants consistently attended treatment sessions and completed between-session homework. Retention was strong, with 65 of 73 (89%) randomized participants completing the outcome assessment. GET was associated with greater post-treatment reductions in avoidance behavior compared to Pacing+ (Cohen's drepeated measures = 0.81), whereas the treatment approach-specific effect of Pacing+ on endurance behavior was less pronounced (Cohen's drepeated measures = 0.39). CONCLUSIONS Findings support a future efficacy-focused clinical trial. GET has the potential to selectively reduce fear avoidance behavior after concussion, and, via this mechanism, to prevent or reduce disability.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Rehabilitation Research Program, Vancouver Coastal Health Research Institute.
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Rehabilitation Research Program, Vancouver Coastal Health Research Institute
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School
| | - Deborah L Snell
- Concussion Clinic, Canterbury District Health Board, Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, University of Calgary, Hotchkiss Brain Institute, University of Calgary
| | - William J Panenka
- British Columbia Neuropsychiatry Program, BC Mental Health and Substance Use Research Institute, Department of Psychiatry, University of British Columbia
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and Spaulding Research Institute, MassGeneral Hospital for Children™ Sports Concussion Program, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program
| | - Chantel T Debert
- Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Hotchhiss Brain Institute, Alberta Children's Hospital Research Institute
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network
| | - Cindy Hunt
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital, Dalla Lana School of Public Health, University of Toronto
| | - Andrew Baker
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry and Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School
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Brown J, Ackley K, Knollman-Porter K. Collaborative Goal Setting: A Clinical Approach for Adults With Mild Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2394-2413. [PMID: 34529919 DOI: 10.1044/2021_ajslp-21-00078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Speech-language pathologists (SLPs) have many available procedural options when setting treatment goals. Extant literature supports goal setting protocols that include and value the perspectives of the client; however, in practice, rehabilitation professionals may lean toward expert models of care when planning treatment. Our purpose is to describe a newly developed approach for SLPs and individuals with mild traumatic brain injury (mTBI) to work together to build meaningful, relevant goals. Method We utilized a multiple case study format to exemplify goal setting procedures. Specifically, we describe procedures and outcomes for a 29-year-old female 28 days postinjury and a 70-year-old male 9 months postinjury. Results Clients who engaged in this protocol worked collaboratively with a clinician to identify strengths and challenges postinjury, select and prioritize goal areas, and discuss and develop meaningful, personalized treatment activities. For both participants, use of the proposed protocol resulted in meaningful goals that addressed their self-reported deficits as well as their respective cognitive-linguistic deficits noted on objective, standardized measures. Conclusions Clinician and client collaboration during treatment goal development can facilitate increased client motivation and functional outcomes. The described approach is feasible from a clinical resource standpoint and promotes a systematic approach to placing the client at the forefront of clinical decision making to enhance therapeutic gains. Such client-centered approaches may be particularly valuable for individuals with mTBI who experience substantial cognitive and communicative challenges but may maintain high levels of self-awareness postinjury.
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Affiliation(s)
- Jessica Brown
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ
| | - Kristen Ackley
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ
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Glendon K, Blenkinsop G, Belli A, Pain M. Prospective study with specific Re-Assessment time points to determine time to recovery following a Sports-Related Concussion in university-aged student-athletes. Phys Ther Sport 2021; 52:287-296. [PMID: 34715487 DOI: 10.1016/j.ptsp.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Time to recovery for symptom burden and neurocognition following a Sports-Related Concussion (SRC) has previously been determined by consolidating varying re-assessment time points into a singular point, and has not been established for Vestibular-Ocular-Motor (VOM) function or academic ability. OBJECTIVES Establish when recovery of symptom burden, neurocognition, VOM function, and academic ability occurs in university-aged student-athletes. METHODS Student-athletes completed an assessment battery (Post-Concussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Vestibular Ocular-Motor Screening (VOMS), Perceived Academic Impairment Tool (PAIT)) during pre-season (n = 140), within 48 hours, 4, 8 and 14 days post-SRC and prior to Return To Play (RTP) and were managed according to the Rugby Football Union' community pathway (n = 42). Student-athletes were deemed recovered or impaired according to Reliable Change Index' (RCI) or compared to their individual baseline. RESULTS Symptom burden recovers by four days post-SRC on RCI and to baseline by eight days. VOM function and academic ability recovers by 8 days. Some student-athletes demonstrated worse performance at RTP on all tests by RCI and to baseline, except for on VOMS score and near point convergence by RCI change. CONCLUSIONS Variation in individual university-aged student-athletes requires a multi-faceted approach to establish what dysfunctions post-SRC exist and when recovery occurs.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, University of Birmingham, UK
| | - M Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Gut microbiome depletion and repetitive mild traumatic brain injury differentially modify bone development in male and female adolescent rats. Bone Rep 2021; 15:101123. [PMID: 34553007 PMCID: PMC8441164 DOI: 10.1016/j.bonr.2021.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/14/2021] [Accepted: 08/27/2021] [Indexed: 11/21/2022] Open
Abstract
Dysregulation of the gut microbiome has been shown to disrupt both bone formation and bone resorption in several preclinical and clinical models. However, the role of microbiome in adolescent bone development remains poorly understood. This effect of disrupted bone development may be more pronounced during adolescence, when bone development is vulnerable to environmental stimuli and external insults (e.g., antibiotic treatment and traumatic brain injury), as this is a critical window of development. Therefore, in this study, we sought to investigate the effect of repetitive mild traumatic brain injury (RmTBI) and gut microbiome depletion by antibiotic treatment on femur length and bone density in male and female adolescent Sprague Dawley rats. Rats were randomly assigned to receive standard or antibiotic autoclaved drinking water and to receive sham or RmTBIs injuries. Using micro-computed tomography (μCT), we found sexually dimorphic changes in adolescent bone development in response to microbiome depletion and RmTBI. Specifically, gut microbiome depletion stunted femur growth in males and altered cross sectional bone area (CSA), bone area fraction, and the bone volume of low and mid density bone in the distal metaphyseal region of the femur. Conversely, RmTBI and antibiotic treatment individually disrupted bone growth, bone area fraction, and bone volume of high-density bone within the distal metaphyseal region of the femur in females, but not when combined. Therefore, findings from this study indicate that gut microbiome and RmTBI may alter bone development in a sex-dependent manner during adolescence.
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Covington NV, Duff MC. Heterogeneity Is a Hallmark of Traumatic Brain Injury, Not a Limitation: A New Perspective on Study Design in Rehabilitation Research. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:974-985. [PMID: 33556261 DOI: 10.1044/2020_ajslp-20-00081] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose In both basic science and intervention research in traumatic brain injury (TBI), heterogeneity in the patient population is frequently cited as a limitation and is often interpreted as a factor reducing certainty in the generalizability of research findings and as a source of conflicting findings across studies. Historically, much of TBI research in rehabilitation and cognition has relied upon case-control studies, with small to modest sample sizes. In this context, heterogeneity is indeed a significant limitation. Here, however, we argue that heterogeneity in patient profiles is a hallmark characteristic of TBI and therefore cannot be avoided or ignored. We argue that this inherent heterogeneity must be acknowledged and accounted for prior to study design. Fortunately, advances in statistical methods and computing power allow researchers to leverage heterogeneity, rather than be constrained by it. Method In this article, we review sources of heterogeneity that contribute to challenges in TBI research, highlight methodological advances in statistical analysis and in other fields with high degrees of heterogeneity (e.g., psychiatry) that may be fruitfully applied to decomposing heterogeneity in TBI, and offer an example from our research group incorporating this approach. Conclusion Only by adopting new methodological approaches can we advance the science of rehabilitation following TBI in ways that will impact clinical practice and inform decision making, allowing us to understand and respond to the range of individual differences that are a hallmark in this population.
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Affiliation(s)
- Natalie V Covington
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa C Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Tayebi M, Holdsworth SJ, Champagne AA, Cook DJ, Nielsen P, Lee TR, Wang A, Fernandez J, Shim V. The role of diffusion tensor imaging in characterizing injury patterns on athletes with concussion and subconcussive injury: a systematic review. Brain Inj 2021; 35:621-644. [PMID: 33843389 DOI: 10.1080/02699052.2021.1895313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Traumatic brain injury (TBI) is a major public health problem. The majority of TBIs are in the form of mild TBI (also known as concussion) with sports-related concussion (SRC) receiving public attention in recent years.Here we have performed a systematic review of the literature on the use of Diffusion Tensor Imaging (DTI) on sports-related concussion and subconcussive injuries. Our review found different patterns of change in DTI parameters between concussed and subconcussed groups. The Fractional Anisotropy (FA) was either unchanged or increased for the concussion group, while the subconcussed group generally experienced a decrease in FA. A reverse pattern was observed for Mean Diffusivity (MD) - where the concussed group experienced a decrease in MD while the subconcussed group showed an increase in MD. However, in general, discrepancies were observed in the results reported in the literature - likely due to the huge variations in DTI acquisition parameters, and image processing and analysis methods used in these studies. This calls for more comprehensive and well-controlled studies in this field, including those that combine the advanced brain imaging with biomechancial modeling and kinematic sensors - to shed light on the underlying mechanisms behind the structural changes observed from the imaging studies.
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Affiliation(s)
- Maryam Tayebi
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Samantha J Holdsworth
- Department of Anatomy and Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Mātai Medical Research Insitute, Gisborne, New Zealand
| | - Allen A Champagne
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Poul Nielsen
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tae-Rin Lee
- Advanced Institute of Convergence Technology, Seoul National University, Seoul, Republic of Korea
| | - Alan Wang
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Anatomy and Medical Imaging & Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Dumitru I, Zorilă MV, Ţolescu RŞ, Racilă L, Pascu CI, Oprica AC, Burghilă DV, Matei L, Vîlcea EJ, Popescu C, Badea-Voiculescu O, Mogoantă L. Experimental model for the study of traumatic brain injury. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:729-737. [PMID: 33817714 PMCID: PMC8112795 DOI: 10.47162/rjme.61.3.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Traumatic brain injury (TBI) represents a public healthcare problem and a major economic burden, all over the world. It is estimated that every year, on the globe, there occur about two million severe TBI and over 42 million mild TBI. The main causes of TBI in civil population are fallings, followed by car accidents. In the last decades, the accelerated development of car industry and the poor development of traffic infrastructure in low- and average-income countries led to an increasing number of brain injuries, this becoming a major problem for medical health systems. According to some studies, approximately 1.35 million people die every year because of car accidents. In the last four decades, these types of injuries started to be studied in order to understand the lesion mechanisms for developing new safety equipment that may be installed on vehicles. The device presented by us for causing a TBI in a lab rat (mechanical pendulum) allows the performance of several major types of TBI, according to the kinetic energy, exposure area, contact surface, etc. The impact energies obtained by the device we presented may vary on a large scale, from less than 1 J up to 10 J, according to its weight, launching angle and impact head shape, thus being obtained minor, moderate or severe TBI.
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Affiliation(s)
- Ilie Dumitru
- Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, Romania;
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24
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Dennis EL, Caeyenberghs K, Asarnow RF, Babikian T, Bartnik-Olson B, Bigler ED, Figaji A, Giza CC, Goodrich-Hunsaker NJ, Hodges CB, Hoskinson KR, Königs M, Levin HS, Lindsey HM, Livny A, Max JE, Merkley TL, Newsome MR, Olsen A, Ryan NP, Spruiell MS, Suskauer SJ, Thomopoulos SI, Ware AL, Watson CG, Wheeler AL, Yeates KO, Zielinski BA, Thompson PM, Tate DF, Wilde EA. Challenges and opportunities for neuroimaging in young patients with traumatic brain injury: a coordinated effort towards advancing discovery from the ENIGMA pediatric moderate/severe TBI group. Brain Imaging Behav 2021; 15:555-575. [PMID: 32734437 PMCID: PMC7855317 DOI: 10.1007/s11682-020-00363-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability in children in both developed and developing nations. Children and adolescents suffer from TBI at a higher rate than the general population, and specific developmental issues require a unique context since findings from adult research do not necessarily directly translate to children. Findings in pediatric cohorts tend to lag behind those in adult samples. This may be due, in part, both to the smaller number of investigators engaged in research with this population and may also be related to changes in safety laws and clinical practice that have altered length of hospital stays, treatment, and access to this population. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric Moderate/Severe TBI (msTBI) group aims to advance research in this area through global collaborative meta-analysis of neuroimaging data. In this paper, we discuss important challenges in pediatric TBI research and opportunities that we believe the ENIGMA Pediatric msTBI group can provide to address them. With the paucity of research studies examining neuroimaging biomarkers in pediatric patients with TBI and the challenges of recruiting large numbers of participants, collaborating to improve statistical power and to address technical challenges like lesions will significantly advance the field. We conclude with recommendations for future research in this field of study.
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Affiliation(s)
- Emily L Dennis
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA.
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Boston, MA, USA.
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Robert F Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- Brain Research Institute, UCLA, Los Angeles, CA, USA
- Department of Psychology, UCLA, Los Angeles, CA, USA
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
| | - Brenda Bartnik-Olson
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Erin D Bigler
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Anthony Figaji
- Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Christopher C Giza
- UCLA Steve Tisch BrainSPORT Program, Los Angeles, CA, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Naomi J Goodrich-Hunsaker
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Cooper B Hodges
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Kristen R Hoskinson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Marsh Königs
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Emma Neuroscience Group, Amsterdam, The Netherlands
| | - Harvey S Levin
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Hannah M Lindsey
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Abigail Livny
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Tel-Hashomer, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Tel-Hashomer, Israel
| | - Jeffrey E Max
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
- Department of Psychiatry, Rady Children's Hospital, San Diego, CA, USA
| | - Tricia L Merkley
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Mary R Newsome
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nicholas P Ryan
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Matthew S Spruiell
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, MD, USA
- Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Christopher G Watson
- Department of Pediatrics, Children's Learning Institute, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anne L Wheeler
- Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, Canada
- Physiology Department, University of Toronto, Toronto, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Brandon A Zielinski
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine of USC, Marina del Rey, Los Angeles, CA, USA
- Departments of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and Ophthalmology, USC, Los Angeles, CA, USA
| | - David F Tate
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
- Missouri Institute of Mental Health and University of Missouri, St Louis, MO, USA
| | - Elisabeth A Wilde
- TBI and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E. Wahlen Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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25
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Philippi CL, Velez CS, Wade BSC, Drennon AM, Cooper DB, Kennedy JE, Bowles AO, Lewis JD, Reid MW, York GE, Newsome MR, Wilde EA, Tate DF. Distinct patterns of resting-state connectivity in U.S. service members with mild traumatic brain injury versus posttraumatic stress disorder. Brain Imaging Behav 2021; 15:2616-2626. [PMID: 33759113 DOI: 10.1007/s11682-021-00464-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 12/27/2022]
Abstract
Mild traumatic brain injury (mTBI) is highly prevalent in military populations, with many service members suffering from long-term symptoms. Posttraumatic stress disorder (PTSD) often co-occurs with mTBI and predicts worse clinical outcomes. Functional neuroimaging research suggests there are both overlapping and distinct patterns of resting-state functional connectivity (rsFC) in mTBI versus PTSD. However, few studies have directly compared rsFC of cortical networks in military service members with these two conditions. In the present study, U.S. service members (n = 137; ages 19-59; 120 male) underwent resting-state fMRI scans. Participants were divided into three study groups: mTBI only, PTSD only, and orthopedically injured (OI) controls. Analyses investigated group differences in rsFC for cortical networks: default mode (DMN), frontoparietal (FPN), salience, somatosensory, motor, auditory, and visual. Analyses were family-wise error (FWE) cluster-corrected and Bonferroni-corrected for number of network seeds regions at the whole brain level (pFWE < 0.002). Both mTBI and PTSD groups had reduced rsFC for DMN and FPN regions compared with OI controls. These group differences were largely driven by diminished connectivity in the PTSD group. rsFC with the middle frontal gyrus of the FPN was increased in mTBI, but decreased in PTSD. Overall, these results suggest that PTSD symptoms may have a more consistent signal than mTBI. Our novel findings of opposite patterns of connectivity with lateral prefrontal cortex highlight a potential biomarker that could be used to differentiate between these conditions.
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Affiliation(s)
- Carissa L Philippi
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
| | - Carmen S Velez
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.,University of Utah, Salt Lake City, UT, USA
| | - Benjamin S C Wade
- University of Utah, Salt Lake City, UT, USA.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, CA, USA
| | - Ann Marie Drennon
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA
| | - Douglas B Cooper
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA.,Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jan E Kennedy
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA
| | - Amy O Bowles
- Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Jeffrey D Lewis
- Brooke Army Medical Center, San Antonio, TX, USA.,Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Matthew W Reid
- Defense and Veterans Brain Injury Center at the San Antonio VA Polytrauma Center, San Antonio, TX, USA
| | | | - Mary R Newsome
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,H. Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX, USA
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26
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Safar K, Zhang J, Emami Z, Gharehgazlou A, Ibrahim G, Dunkley BT. Mild traumatic brain injury is associated with dysregulated neural network functioning in children and adolescents. Brain Commun 2021; 3:fcab044. [PMID: 34095832 PMCID: PMC8176148 DOI: 10.1093/braincomms/fcab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
Mild traumatic brain injury is highly prevalent in paediatric populations, and can result in chronic physical, cognitive and emotional impairment, known as persistent post-concussive symptoms. Magnetoencephalography has been used to investigate neurophysiological dysregulation in mild traumatic brain injury in adults; however, whether neural dysrhythmia persists in chronic mild traumatic brain injury in children and adolescents is largely unknown. We predicted that children and adolescents would show similar dysfunction as adults, including pathological slow-wave oscillations and maladaptive, frequency-specific, alterations to neural connectivity. Using magnetoencephalography, we investigated regional oscillatory power and distributed brain-wide networks in a cross-sectional sample of children and adolescents in the chronic stages of mild traumatic brain injury. Additionally, we used a machine learning pipeline to identify the most relevant magnetoencephalography features for classifying mild traumatic brain injury and to test the relative classification performance of regional power versus functional coupling. Results revealed that the majority of participants with chronic mild traumatic brain injury reported persistent post-concussive symptoms. For neurophysiological imaging, we found increased regional power in the delta band in chronic mild traumatic brain injury, predominantly in bilateral occipital cortices and in the right inferior temporal gyrus. Those with chronic mild traumatic brain injury also showed dysregulated neuronal coupling, including decreased connectivity in the delta range, as well as hyper-connectivity in the theta, low gamma and high gamma bands, primarily involving frontal, temporal and occipital brain areas. Furthermore, our multivariate classification approach combined with functional connectivity data outperformed regional power in terms of between-group classification accuracy. For the first time, we establish that local and large-scale neural activity are altered in youth in the chronic phase of mild traumatic brain injury, with the majority presenting persistent post-concussive symptoms, and that dysregulated interregional neural communication is a reliable marker of lingering paediatric ‘mild’ traumatic brain injury.
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Affiliation(s)
- Kristina Safar
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4
| | - Jing Zhang
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4
| | - Zahra Emami
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4
| | - Avideh Gharehgazlou
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada M5S 1A8
| | - George Ibrahim
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4.,Department of Surgery, University of Toronto, Toronto, ON, Canada M5T 1P5.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G9 Canada
| | - Benjamin T Dunkley
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada M5G 0A4.,Neurosciences & Mental Health, SickKids Research Institute, Toronto, ON, Canada M5G 0A4.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada M5T 1W7
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27
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Hergert DC, Robertson-Benta C, Sicard V, Schwotzer D, Hutchison K, Covey DP, Quinn DK, Sadek JR, McDonald J, Mayer AR. Use of Medical Cannabis to Treat Traumatic Brain Injury. J Neurotrauma 2021; 38:1904-1917. [PMID: 33256496 DOI: 10.1089/neu.2020.7148] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is not a single pharmacological agent with demonstrated therapeutic efficacy for traumatic brain injury (TBI). With recent legalization efforts and the growing popularity of medical cannabis, patients with TBI will inevitably consider medical cannabis as a treatment option. Pre-clinical TBI research suggests that cannabinoids have neuroprotective and psychotherapeutic properties. In contrast, recreational cannabis use has consistently shown to have detrimental effects. Our review identified a paucity of high-quality studies examining the beneficial and adverse effects of medical cannabis on TBI, with only a single phase III randomized control trial. However, observational studies demonstrate that TBI patients are using medical and recreational cannabis to treat their symptoms, highlighting inconsistencies between public policy, perception of potential efficacy, and the dearth of empirical evidence. We conclude that randomized controlled trials and prospective studies with appropriate control groups are necessary to fully understand the efficacy and potential adverse effects of medical cannabis for TBI.
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Affiliation(s)
- Danielle C Hergert
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Cidney Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Veronik Sicard
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA
| | - Daniela Schwotzer
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Kent Hutchison
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado, USA
| | - Dan P Covey
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Davin K Quinn
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Joseph R Sadek
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,New Mexico VA Health Care System, Albuquerque, New Mexico, USA
| | - Jacob McDonald
- Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico, USA
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, Albuquerque, New Mexico, USA.,Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.,Psychology Department, University of New Mexico, Albuquerque, New Mexico, USA
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28
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Crampton A, Teel E, Chevignard M, Gagnon I. Vestibular-ocular reflex dysfunction following mild traumatic brain injury: A narrative review. Neurochirurgie 2021; 67:231-237. [PMID: 33482235 DOI: 10.1016/j.neuchi.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/10/2021] [Indexed: 12/28/2022]
Abstract
Mild traumatic brain injury (mTBI) is a prevalent injury which occurs across many populations, including children and adolescents, athletes, military personnel, and the elderly. mTBI can result in various subjective symptoms and clinical deficits, such as abnormalities to the vestibulo-ocular reflex (VOR). Over 50% of individuals with mTBI are reported to have VOR abnormalities, which strongly contribute to feelings of dizziness and unsteadiness. Dizziness is a strong predictor for prolonged recovery following mTBI and is additionally linked with mental health difficulties and functional limitations affecting likelihood of return to work. Early diagnosis, and subsequent treatment, of VOR deficits following mTBI may greatly improve recovery outcomes and a patient's quality of life, but a thorough comprehension of the related pathophysiology is necessary to understand the assessments used to diagnose VOR abnormalities. Therefore, the purpose of this article is i) provide readers with an introduction on the VOR physiology to facilitate understanding about mTBI-related abnormalities, and ii) to discuss current assessments that are commonly used to measure VOR function following mTBI. As the VOR and oculomotor (OM) systems are heavily linked and often work in tandem, discussion of the relevant aspects of the OM system is also provided.
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Affiliation(s)
- Adrienne Crampton
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.
| | - Elizabeth Teel
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada
| | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, INSERM, CNRS, Paris, France; GRC 24 HaMCRe, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada; Montreal Children Hospital, McGill University Health Center, Montreal, QC, Canada
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29
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Stika MM, Riordan P, Aaronson A, Herrold AA, Ellison RL, Kletzel S, Drzewiecki M, Evans CT, Mallinson T, High WM, Babcock-Parziale J, Urban A, Pape TLB, Smith B. Cognition and Other Predictors of Functional Disability Among Veterans With Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. J Head Trauma Rehabil 2021; 36:44-55. [PMID: 32898030 PMCID: PMC8916049 DOI: 10.1097/htr.0000000000000611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limitations in everyday functioning are frequently reported by veterans with a history of mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). Multiple factors are associated with functional disability among veterans, including depression, poor social support, cognition, and substance use. However, the degree to which these factors, particularly cognitive capacities, contribute to functional limitations remains unclear. METHODS We evaluated performance on tests of processing speed, executive functioning, attention, and memory as predictors of functioning on the World Health Organization Disability Assessment Scale (WHODAS) 2.0 in 288 veterans. Participants were placed in one of the following groups: PTSD-only, mTBI-only, mTBI + PTSD, and neither PTSD nor mTBI (deployed control group). Cognitive test performances were evaluated as predictors of WHODAS 2.0 functional ratings in regression models that included demographic variables and a range of mood, behavioral health, and postconcussive symptom ratings. RESULTS Multiple cognitive test performances predicted WHODAS 2.0 scores in the deployed control group, but they generally did not predict functioning in the clinical groups when accounting for demographics, mood, behavioral health, and postconcussive symptoms. CONCLUSIONS In veterans with mTBI and/or PTSD, cognitive test performances are less associated with everyday functioning than mood and postconcussive symptoms.
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Affiliation(s)
- Monica M Stika
- Department of Veterans Affairs (VA), Edward Hines, Jr. VA Hospital: Spinal Cord Injury/Disorder Service (Dr Stika), Mental Health Service Line: Neuropsychology Service (Drs Riordan, Drzewiecki, and Urban) and Psychiatry Service (Dr Aaronson), Research Service (Drs Bender Pape, Herrold, Kletzel, and Ellison), Center of Innovation for Complex Chronic Healthcare (Drs Bender Pape, Herrold, Kletzel, Smith, and Evans), Hines, Illinois; Departments of Psychiatry & Behavioral Sciences (Drs Aaronson and Herrold), Physical Medicine and Rehabilitation (Dr Pape), and Pediatrics (Dr Smith), and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine (Dr Evans), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Clinical Research and Leadership, The George Washington University, Washington, District of Columbia (Dr Mallinson); Department of Veterans Affairs (VA), New Mexico VA Health Care System, Albuquerque (Dr High); Illinois Institute of Technology (IIT), Chicago (Dr Ellison); and Department of Veterans Affairs (VA), Southern AZ VA Health Care System (3-124), Tucson, Arizona (Dr Babcock-Parziale)
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30
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Wallace J, Learman K, Moran R, Covassin T, Deitrick JM, Delfin D, Shina J. Premorbid anxiety and depression and baseline neurocognitive, ocular-motor and vestibular performance: A retrospective cohort study. J Neurol Sci 2020; 418:117110. [PMID: 32882438 DOI: 10.1016/j.jns.2020.117110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/28/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Concussion has become a growing concern among sport and healthcare practitioners. Experts continue to investigate ways to advance the quality of concussion evaluation, diagnosis and management. Psychological conditions have been reported to influence concussion assessment outcomes at baseline and post-concussion; however, little evidence has examined psychological conditions and their effect on multifaceted measures of concussion. A retrospective cohort design was employed to examine differences between those with and without a premorbid psychological condition for high school and collegiate athletes who completed a preseason baseline battery, consisting of symptom reporting, computerized neurocognitive assessment, Vestibular-Ocular Motor Screening (VOMS), and the King-Devick (KD) test. Forty athletes within the sample self-reported a diagnosed psychological risk factor, consisting of depression and/or anxiety, and each were matched with a discordant control. Controls were matched on sex, age, sport, concussion history and ocular history. Athletes with psychological conditions reported higher symptom severity and had worse visual motor speed than controls. There were no differences between groups on other neurocognitive domains, VOMS, or KD. These results suggest that vestibular-ocular tools may be more consistent or less likely to vary between those with and without a premorbid psychological diagnosis, adding value to tools such as the KD and VOMS.
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Affiliation(s)
- Jessica Wallace
- Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 Beeghly Center, Youngstown, OH 44555, United States of America; Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America.
| | - Ken Learman
- Department of Physical Therapy, Youngstown State University, 1 University Plaza, Cushwa Hall B307 Youngstown, OH 44555, United States of America.
| | - Ryan Moran
- Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America.
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, 105 IM Sports Circle, East Lansing, MI 48824, United States of America.
| | | | - Danae Delfin
- Department of Health Science, Athletic Training, University of Alabama, 270 Kilgore, Lane, Capital Hall, Tuscaloosa, AL 35487, United States of America.
| | - James Shina
- Kinesiology & Sport Science Department, Youngstown State University, 1 University Plaza, 307 Beeghly Center, Youngstown, OH 44555, United States of America
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31
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Martinez-Tapia RJ, Estrada-Rojo F, Lopez-Aceves TG, Rodríguez-Mata V, Perez-Torres A, Barajas-Martinez A, Garcia-Velasco S, Ugalde-Muñiz P, Navarro L. Diurnal Variation Induces Neurobehavioral and Neuropathological Differences in a Rat Model of Traumatic Brain Injury. Front Neurosci 2020; 14:564992. [PMID: 33132827 PMCID: PMC7550533 DOI: 10.3389/fnins.2020.564992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/25/2020] [Indexed: 01/21/2023] Open
Abstract
Traumatic brain injury (TBI) induces two types of brain damage: primary and secondary. Damage initiates a series of pathophysiological processes, such as metabolic crisis, excitotoxicity with oxidative stress-induced damage, and neuroinflammation. The long-term perpetuation of these processes has deleterious consequences for neuronal function. However, it remains to be elucidated further whether physiological variation in the brain microenvironment, depending on diurnal variations, influences the damage, and consequently, exerts a neuroprotective effect. Here, we established an experimental rat model of TBI and evaluated the effects of TBI induced at two different time points of the light–dark cycle. Behavioral responses were assessed using a 21-point neurobehavioral scale and the cylinder test. Morphological damage was assessed in different regions of the central nervous system. We found that rats that experienced a TBI during the dark hours had better behavioral performance than those injured during the light hours. Differences in behavioral performance correlated with less morphological damage in the perilesional zone. Moreover, certain brain areas (CA1 and dentate gyrus subregions of the hippocampus) were less prone to damage in rats that experienced a TBI during the dark hours. Our results suggest that diurnal variation is a crucial determinant of TBI outcome, and the hour of the day at which an injury occurs should be considered for future research.
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Affiliation(s)
| | - Francisco Estrada-Rojo
- Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Teresita Guadalupe Lopez-Aceves
- Programa Regional de Posgrado en Biotecnologia, Facultad de Ciencias Quimico Biologicas, Universidad Autonoma de Sinaloa, Culiacán, Mexico
| | - Veronica Rodríguez-Mata
- Departamento de Biologia Celular y Tisular, Facultad de Medicina, Universidad Nacional Autonoma de México, Mexico City, Mexico
| | - Armando Perez-Torres
- Departamento de Biologia Celular y Tisular, Facultad de Medicina, Universidad Nacional Autonoma de México, Mexico City, Mexico
| | - Antonio Barajas-Martinez
- Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Stephany Garcia-Velasco
- Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Perla Ugalde-Muñiz
- Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Luz Navarro
- Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
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32
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Giudice JS, Alshareef A, Wu T, Gancayco CA, Reynier KA, Tustison NJ, Druzgal TJ, Panzer MB. An Image Registration-Based Morphing Technique for Generating Subject-Specific Brain Finite Element Models. Ann Biomed Eng 2020; 48:2412-2424. [PMID: 32725547 DOI: 10.1007/s10439-020-02584-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/22/2020] [Indexed: 01/10/2023]
Abstract
Finite element (FE) models of the brain are crucial for investigating the mechanisms of traumatic brain injury (TBI). However, FE brain models are often limited to a single neuroanatomy because the manual development of subject-specific models is time consuming. The objective of this study was to develop a pipeline to automatically generate subject-specific FE brain models using previously developed nonlinear image registration techniques, preserving both external and internal neuroanatomical characteristics. To verify the morphing-induced mesh distortions did not influence the brain deformation response, strain distributions predicted using the morphed model were compared to those from manually created voxel models of the same subject. Morphed and voxel models were generated for 44 subjects ranging in age, and simulated using head kinematics from a football concussion case. For each subject, brain strain distributions predicted by each model type were consistent, and differences in strain prediction was less than 4% between model type. This automated technique, taking approximately 2 h to generate a subject-specific model, will facilitate interdisciplinary research between the biomechanics and neuroimaging fields and could enable future use of biomechanical models in the clinical setting as a tool for improving diagnosis.
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Affiliation(s)
- J Sebastian Giudice
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA
| | - Ahmed Alshareef
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA
| | - Taotao Wu
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA
| | | | - Kristen A Reynier
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA
| | - Nicholas J Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - T Jason Druzgal
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Matthew B Panzer
- Department of Mechanical and Aerospace Engineering, Center for Applied Biomechanics, University of Virginia, 4040 Lewis and Clark Dr., Charlottesville, VA, 229011, USA. .,Brain Injury and Sports Concussion Center, University of Virginia, Charlottesville, VA, USA.
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33
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Iverson GL, Ivins BJ, Karr JE, Crane PK, Lange RT, Cole WR, Silverberg ND. Comparing Composite Scores for the ANAM4 TBI-MIL for Research in Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2020; 35:56-69. [PMID: 31063188 DOI: 10.1093/arclin/acz021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The Automated Neuropsychological Assessment Metrics (Version 4) Traumatic Brain Injury Military (ANAM4 TBI-MIL) is commonly administered among U.S. service members both pre-deployment and following TBI. The current study used the ANAM4 TBI-MIL to develop a cognition summary score for TBI research and clinical trials, comparing eight composite scores based on their distributions and sensitivity/specificity when differentiating between service members with and without mild TBI (MTBI). METHOD Male service members with MTBI (n = 56; Mdn = 11 days-since-injury) or no self-reported TBI history (n = 733) completed eight ANAM4 TBI-MIL tests. Their throughput scores (correct responses/minute) were used to calculate eight composite scores: the overall test battery mean (OTBM); global deficit score (GDS); neuropsychological deficit score-weighted (NDS-W); low score composite (LSC); number of scores <50th, ≤16th percentile, or ≤5th percentile; and the ANAM Composite Score (ACS). RESULTS The OTBM and ACS were normally distributed. Other composites had skewed, zero-inflated distributions (62.9% had GDS = 0). All composites differed significantly between participants with and without MTBI (p < .001), with deficit scores showing the largest effect sizes (d = 1.32-1.47). The Area Under the Curve (AUC) was lowest for number of scores ≤5th percentile (AUC = 0.653) and highest for the LSC, OTBM, ACS, and NDS-W (AUC = 0.709-0.713). CONCLUSIONS The ANAM4 TBI-MIL has no well-validated composite score. The current study examined multiple candidate composite scores, finding that deficit scores showed larger group differences than the OTBM, but similar AUC values. The deficit scores were highly correlated. Future studies are needed to determine whether these scores show less redundancy among participants with more severe TBIs.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| | - Brian J Ivins
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
| | - Justin E Karr
- Departments of Psychiatry and Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD, USA.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, V6T 2A1, Canada
| | - Wesley R Cole
- Defense and Veterans Brain Injury Center; Intrepid Spirit; Womack Army Medical Center; Fort Bragg, NC, USA
| | - Noah D Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia; Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, British Columbia, V5Z 2G9, Canada
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34
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Ozga-Hess JE, Whirtley C, O'Hearn C, Pechacek K, Vonder Haar C. Unilateral parietal brain injury increases risk-taking on a rat gambling task. Exp Neurol 2020; 327:113217. [PMID: 32014440 DOI: 10.1016/j.expneurol.2020.113217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/03/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
Traumatic brain injury (TBI) affects millions of individuals every year. Many of these injuries lead to lasting effects, particularly impairments in domains broadly classified as executive functions, such as impulse control and decision-making. While these impairments have been historically associated with frontal brain damage, other injuries such as concussion or parietal injury also contribute to similar dysfunction. However, it is unknown whether animal models of TBI would replicate these broad effects that are observed in human patients. In the current study, we delivered a unilateral parietal controlled cortical impact injury and assessed the performance of rats on a motoric task (rotarod) and a test of decision-making and impulsivity (rodent gambling task). TBI rats demonstrated significant motor impairments on the rotarod task; however, this did not extend to difficulties inhibiting motor actions (impulsivity). In addition, TBI caused chronic alterations to risk-based decision-making, extending out to 12 weeks post-injury. Specifically, rats with TBI preferred the riskiest, and most suboptimal option over all others. The current data suggest that models of unilateral TBI are sufficient for replicating some aspects of executive dysfunction (risky decision-making), while others are limited to frontal damage (impulsivity). These models may be used to develop therapeutics targeted at the chronic post-injury period when these symptoms often manifest in patients, a critically understudied area in preclinical TBI research.
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Affiliation(s)
- Jenny E Ozga-Hess
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cory Whirtley
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Christopher O'Hearn
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Kristen Pechacek
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cole Vonder Haar
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, Morgantown, WV, USA; Department of Neuroscience, West Virginia University, Morgantown, WV, USA.
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35
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Tate DF, Wilde EA, York GE, Bigler ED. Neuroimaging in Traumatic Brain Injury Rehabilitation. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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36
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Cook MJ, Gardner AJ, Wojtowicz M, Williams WH, Iverson GL, Stanwell P. Task-related functional magnetic resonance imaging activations in patients with acute and subacute mild traumatic brain injury: A coordinate-based meta-analysis. NEUROIMAGE-CLINICAL 2019; 25:102129. [PMID: 31891819 PMCID: PMC6939096 DOI: 10.1016/j.nicl.2019.102129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/28/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022]
Abstract
ALE meta-analysis revealed functional activation differences in mTBI. Reduced activation identified within the right middle frontal gyrus. Suggests alteration of prefrontal region, associated with executive functioning. Need for addressing subject- and task-specific variation in future studies.
Task-based functional magnetic resonance imaging (fMRI) has been used to examine neuroanatomical and functional changes following mild traumatic brain injury (mTBI). Prior studies have lacked consistency in identifying common regions of altered neural activity during cognitive tasks. This may be partly due to differences in task paradigm, patient heterogeneity, and methods of fMRI analysis. We conducted a meta-analysis using an activation likelihood estimation (ALE) method to identify regions of differential brain activation in patients with mTBI compared to healthy controls. We included experiments that performed scans from acute to subacute time points post-injury. The seven included studies recruited a total sample of 174 patients with mTBIs and 139 control participants. The results of our coordinate based meta-analysis revealed a single cluster of reduced activation within the right middle frontal gyrus (MFG) that differentiated mTBI from healthy controls. We conclude that the cognitive impairments in memory and attention typically reported in mTBI patients may be associated with a deficit in the right MFG, which impacts the recruitment of neural networks important for attentional control.
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Affiliation(s)
- Michael J Cook
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Hunter New England Local Health District Sports Concussion Clinic, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Magdalena Wojtowicz
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - W Huw Williams
- Centre for Clinical Neuropsychology Research, University of Exeter, Exeter, Devon, UK
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital, and Spaulding Research Institute, Charlestown, MA, USA; MassGeneral Hospital for Children™ Sports Concussion Program, Boston, MA, USA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Home Base Program, Charlestown, MA, USA
| | - Peter Stanwell
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia; School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia.
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37
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Motor Effects of Minimal Traumatic Brain Injury in Mice. J Mol Neurosci 2019; 70:365-377. [PMID: 31820347 DOI: 10.1007/s12031-019-01422-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
Traumatic brain injury (TBI) is considered to be the leading cause of disability and death among young people. Up to 30% of mTBI patients report motor impairments, such as altered coordination and impaired balance and gait. The objective of the present study was to characterize motor performance and motor learning changes, in order to achieve a more thorough understanding of the possible motor consequences of mTBI in humans. Mice were exposed to traumatic brain injury using the weight-drop model and subsequently subjected to a battery of behavioral motor tests. Immunohistochemistry was conducted in order to evaluate neuronal survival and synaptic connectivity. TBI mice showed a different walking pattern on the Erasmus ladder task, without any significant impairment in motor performance and motor learning. In the running wheels, mTBI mice showed reduced activity during the second dark phase and increased activity during the second light phase compared to the control mice. There was no difference in the sum of wheel revolutions throughout the experiment. On the Cat-Walk paradigm, the mice showed a wider frontal base of support post mTBI. The same mice spent a significantly greater percent of time standing on three paws post mTBI compared with controls. mTBI mice also showed a decrease in the number of neurons in the temporal cortex compared with the control group. In summary, mTBI mice suffered from mild motor impairments, minor changes in the circadian clock, and neuronal damage. A more in-depth examination of the mechanisms by which mTBI compensate for motor deficits is necessary.
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38
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King NS. ‘Mild Traumatic Brain Injury’ and ‘Sport-related Concussion’: Different languages and mixed messages? Brain Inj 2019; 33:1556-1563. [DOI: 10.1080/02699052.2019.1655794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nigel S. King
- Consultant Clinical Neuropsychologist
- Oxford Institute of Clinical Psychology Training, University of Oxford, Warneford Hospital, Oxford, UK
- Community Head Injury Service, The Camborne Centre, Bucks Healthcare NHS Trust, Aylesbury, UK
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39
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Hoogenboom WS, Rubin TG, Ye K, Cui MH, Branch KC, Liu J, Branch CA, Lipton ML. Diffusion Tensor Imaging of the Evolving Response to Mild Traumatic Brain Injury in Rats. J Exp Neurosci 2019; 13:1179069519858627. [PMID: 31308735 PMCID: PMC6613065 DOI: 10.1177/1179069519858627] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022] Open
Abstract
Mild traumatic brain injury (mTBI), also known as concussion, is a serious public health challenge. Although most patients recover, a substantial minority suffers chronic disability. The mechanisms underlying mTBI-related detrimental effects remain poorly understood. Although animal models contribute valuable preclinical information and improve our understanding of the underlying mechanisms following mTBI, only few studies have used diffusion tensor imaging (DTI) to study the evolution of axonal injury following mTBI in rodents. It is known that DTI shows changes after human concussion and the role of delineating imaging findings in animals is therefore to facilitate understanding of related mechanisms. In this work, we used a rodent model of mTBI to investigate longitudinal indices of axonal injury. We present the results of 45 animals that received magnetic resonance imaging (MRI) at multiple time points over a 2-week period following concussive or sham injury yielding 109 serial observations. Overall, the evolution of DTI metrics following concussive or sham injury differed by group. Diffusion tensor imaging changes within the white matter were most noticeable 1 week following injury and returned to baseline values after 2 weeks. More specifically, we observed increased fractional anisotropy in combination with decreased radial diffusivity and mean diffusivity, in the absence of changes in axial diffusivity, within the white matter of the genu corpus callosum at 1 week post-injury. Our study shows that DTI can detect microstructural white matter changes in the absence of gross abnormalities as indicated by visual screening of anatomical MRI and hematoxylin and eosin (H&E)-stained sections in a clinically relevant animal model of mTBI. Whereas additional histopathologic characterization is required to better understand the neurobiological correlates of DTI measures, our findings highlight the evolving nature of the brain’s response to injury following concussion.
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Affiliation(s)
- Wouter S Hoogenboom
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Department of Clinical Investigation, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Todd G Rubin
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Kenny Ye
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Min-Hui Cui
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Kelsey C Branch
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Jinyuan Liu
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Craig A Branch
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Department of Physiology and Biophysics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Michael L Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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40
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Yeates KO, Tang K, Barrowman N, Freedman SB, Gravel J, Gagnon I, Sangha G, Boutis K, Beer D, Craig W, Burns E, Farion KJ, Mikrogianakis A, Barlow K, Dubrovsky AS, Meeuwisse W, Gioia G, Meehan WP, Beauchamp MH, Kamil Y, Grool AM, Hoshizaki B, Anderson P, Brooks BL, Vassilyadi M, Klassen T, Keightley M, Richer L, DeMatteo C, Osmond MH, Zemek R, Xie J, Chatfield J, Dow N, Papadimitropoulos R, Levesque T, Langford C, Tran TT, McGahern C, DiGirolamo V, Mazza J, Lagacé M, Cook R, Fitzpatrick E, MacIntyre J, Moore J. Derivation and Initial Validation of Clinical Phenotypes of Children Presenting with Concussion Acutely in the Emergency Department: Latent Class Analysis of a Multi-Center, Prospective Cohort, Observational Study. J Neurotrauma 2019; 36:1758-1767. [DOI: 10.1089/neu.2018.6009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth Tang
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Stephen B. Freedman
- Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Pediatrics, Hospital Sainte Justine, University of Montreal, Montreal, Quebec, Canada
| | - Isabelle Gagnon
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Gurinder Sangha
- Department of Pediatrics, Children's Hospital of Western Ontario, Western University, London, Ontario, Canada
| | - Kathy Boutis
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Darcy Beer
- Department of Pediatrics, Manitoba Children's Hospital, Winnipeg, Manitoba, Canada
| | - William Craig
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Emma Burns
- Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ken J. Farion
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Alberta
| | - Karen Barlow
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Alberta
| | - Alexander S. Dubrovsky
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gerard Gioia
- Department of Neuropsychology, Children's National Health System, George Washington University School of Medicine, Rockville, Maryland
| | - William P. Meehan
- Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts
| | - Miriam H. Beauchamp
- Ste. Justine Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Yael Kamil
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Anne M. Grool
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Blaine Hoshizaki
- Department of Kinesiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Anderson
- Department of Psychology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Brian L. Brooks
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michael Vassilyadi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Terry Klassen
- Department of Pediatrics, Manitoba Children's Hospital, Winnipeg, Manitoba, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lawrence Richer
- Department of Neurology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Carol DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Martin H. Osmond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Abstract
The underlying mechanisms that result in neurophysiological changes and cognitive sequelae in the context of repetitive mild traumatic brain injury (rmTBI) remain poorly understood. Animal models provide a unique opportunity to examine cellular and molecular responses using histological assessment, which can give important insights on the neurophysiological changes associated with the evolution of brain injury. To better understand the potential cumulative effects of multiple concussions, the focus of animal models is shifting from single to repetitive head impacts. With a growing body of literature on this subject, a review and discussion of current findings is valuable to better understand the neuropathology associated with rmTBI, to evaluate the current state of the field, and to guide future research efforts. Despite variability in experimental settings, existing animal models of rmTBI have contributed to our understanding of the underlying mechanisms following repeat concussion. However, how to reconcile the various impact methods remains one of the major challenges in the field today.
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Affiliation(s)
- Wouter S Hoogenboom
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Clinical Investigation, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA.
| | - Craig A Branch
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Physiology and Biophysics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
| | - Michael L Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; Departments of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
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42
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Rubin TG, Lipton ML. Sex Differences in Animal Models of Traumatic Brain Injury. J Exp Neurosci 2019; 13:1179069519844020. [PMID: 31205421 PMCID: PMC6537488 DOI: 10.1177/1179069519844020] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI) is highly prevalent and there is currently no adequate treatment. Understanding the underlying mechanisms governing TBI and recovery remains an elusive goal. The heterogeneous nature of injury and individual's response to injury have made understanding risk and susceptibility to TBI of great importance. Epidemiologic studies have provided evidence of sex-dependent differences following TBI. However, preclinical models of injury have largely focused on adult male animals. Here, we review 50 studies that have investigated TBI in both sexes using animal models. Results from these studies are highly variable and model dependent, but largely show females to have a protective advantage in behavioral outcomes and pathology following TBI. Further research of both sexes using newer models that better recapitulate mild and repetitive TBI is needed to characterize the nature of sex-dependent injury and recovery, and ultimately identifies targets for enhanced recovery.
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Affiliation(s)
- Todd G Rubin
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Rose F. Kennedy Center, Bronx, NY, USA.,Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael L Lipton
- The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Rose F. Kennedy Center, Bronx, NY, USA.,Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx NY, USA.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
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43
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Rytter HM, Westenbaek K, Henriksen H, Christiansen P, Humle F. Specialized interdisciplinary rehabilitation reduces persistent post-concussive symptoms: a randomized clinical trial. Brain Inj 2018; 33:266-281. [DOI: 10.1080/02699052.2018.1552022] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hana Mala Rytter
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | | | | | - Frank Humle
- Centre for Rehabilitation of Brain Injury, Copenhagen, Denmark
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44
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Vonder Haar C, Ferland JMN, Kaur S, Riparip LK, Rosi S, Winstanley CA. Cocaine self-administration is increased after frontal traumatic brain injury and associated with neuroinflammation. Eur J Neurosci 2018; 50:2134-2145. [PMID: 30118561 DOI: 10.1111/ejn.14123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022]
Abstract
Traumatic brain injury (TBI) has been linked to the development of numerous psychiatric diseases, including substance use disorder. However, it can be difficult to ascertain from clinical data whether the TBI is cause or consequence of increased addiction vulnerability. Surprisingly few studies have taken advantage of animal models to investigate the causal nature of this relationship. In terms of a plausible neurobiological mechanism through which TBI could magnify the risk of substance dependence, numerous studies indicate that TBI can cause widespread disruption to monoaminergic signaling in striatal regions, and also increases neuroinflammation. In the current study, male Long-Evans rats received either a mild or severe TBI centered over the frontal cortex via controlled cortical impact, and were subsequently trained to self-administer cocaine over 10 6-hour sessions. At the end of the study, markers of striatal dopaminergic function, and levels of inflammatory cytokine levels in the frontal lobes, were assessed via western blot and multiplex ELISA, respectively. There was significantly higher cocaine intake in a subset of animals with either mild or severe TBI. However, many animals within both TBI groups failed to acquire self-administration. Principal components analysis suggested that both dopaminergic and neuroinflammatory proteins were associated with overall cocaine intake, yet only an inflammatory component was associated with acquisition of self-administration, suggesting neuroinflammation may make a more substantial contribution to the likelihood of drug-taking. Should neuroinflammation play a causal role in mediating TBI-induced addiction risk, anti-inflammatory therapy may reduce the likelihood of substance abuse in TBI populations.
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Affiliation(s)
- Cole Vonder Haar
- Injury and Recovery Laboratory, Department of Psychology, West Virginia University, PO Box 6040, 53 Campus Drive, Morgantown, WV, 26505, USA.,Laboratory of Molecular and Behavioural Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Jacqueline-Marie N Ferland
- Laboratory of Molecular and Behavioural Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sukhbir Kaur
- Laboratory of Molecular and Behavioural Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lara-Kirstie Riparip
- Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Susanna Rosi
- Brain and Spinal Injury Center, Departments of Physical Therapy Rehabilitation Science and Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Catharine A Winstanley
- Laboratory of Molecular and Behavioural Neuroscience, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
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45
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Reynolds BB, Stanton AN, Soldozy S, Goodkin HP, Wintermark M, Druzgal TJ. Investigating the effects of subconcussion on functional connectivity using mass-univariate and multivariate approaches. Brain Imaging Behav 2018; 12:1332-1345. [PMID: 29188492 PMCID: PMC6141348 DOI: 10.1007/s11682-017-9790-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
There are concerns about the effects of subconcussive head impacts in sport, but the effects of subconcussion on brain connectivity are not well understood. We hypothesized that college football players experience changes in brain functional connectivity not found in athletes competing in lower impact sports or healthy controls. These changes may be spatially heterogeneous across participants, requiring analysis methods that go beyond mass-univariate approaches commonly used in functional MRI (fMRI). To test this hypothesis, we analyzed resting-state fMRI data from college football (n = 15), soccer (n = 12), and lacrosse players (n = 16), and controls (n = 29) collected at preseason and postseason time points. Regional homogeneity (ReHo) and degree centrality (DC) were calculated as measures of local and long-range functional connectivity, respectively. Standard voxel-wise analysis and paired support vector machine (SVM) classification studied subconcussion's effects on local and global functional connectivity. Voxel-wise analyses yielded minimal findings, but SVM classification had high accuracy for college football's ReHo (87%, p = 0.009) and no other group. The findings suggest subconcussion results in spatially heterogeneous changes in local functional connectivity that may only be detectible with multivariate analyses. To determine if voxel-wise and SVM analyses had similar spatial patterns, region-average t-statistic and SVM weight values were compared using a measure of ranking distance. T-statistic and SVM weight rankings exhibited significantly low ranking distance values for all groups and metrics, demonstrating that the analyses converged on a similar underlying effect. Overall, this research suggests that subconcussion in football may produce local functional connectivity changes similar to concussion.
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Affiliation(s)
- Bryson B Reynolds
- Department of Radiology and Medical Imaging, Division of Neuroradiology, University of Virginia, Charlottesville, VA, 22908, USA
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Amanda N Stanton
- Department of Radiology and Medical Imaging, Division of Neuroradiology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Sauson Soldozy
- Department of Radiology and Medical Imaging, Division of Neuroradiology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Howard P Goodkin
- Department of Neurology, University of Virginia, Charlottesville, VA, 22908, USA
- UVA Brain Institute, University of Virginia, Charlottesville, VA, 22908, USA
| | | | - T Jason Druzgal
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- UVA Brain Institute, University of Virginia, Charlottesville, VA, 22908, USA.
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46
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Teferra K, Tan XG, Iliopoulos A, Michopoulos J, Qidwai S. Effect of human head morphological variability on the mechanical response of blast overpressure loading. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3109. [PMID: 29804323 DOI: 10.1002/cnm.3109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
A methodology is introduced to investigate the effect of intersubject head morphological variability on the mechanical response of the brain when subjected to blast overpressure loading. Nonrigid image registration techniques are leveraged to warp a manually segmented template model to an arbitrary number of subjects following a procedure to coarsely segment the subjects in batch. Finite element meshes are autogenerated, and blast analysis is conducted. The template model is initially constructed to enable the full automated implementation and application of the proposed methodology. The application of the proposed approach for an anterior-oriented blast has been demonstrated, and the results reveal that the pressure response in the brain does exhibit some dependence on head morphological variability. While the magnitude of the peak pressure response can vary by more than 30%, its location within the brain is unaffected by head morphological variability. A linear least squares analysis was conducted to demonstrate that the peak magnitude of pressure is uncorrelated with head volume while it is correlated with aspect ratio relating to the amount of exposed surface area to the blast. These features of the pressure response are likely due to the peak pressure occurring during the early stages of stress wave transmission and reflection. As a result, the pressure response due to blast overpressure loading is predominantly loading dependent while morphological variability has a secondary effect.
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Affiliation(s)
| | - X Gary Tan
- US Naval Research Laboratory, Washington, DC, USA
| | | | | | - Siddiq Qidwai
- Division of Civil, Mechanical and Manufacturing Innovation, NSF, Alexandria, VA, USA
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Mayer AR, Kaushal M, Dodd AB, Hanlon FM, Shaff NA, Mannix R, Master CL, Leddy JJ, Stephenson D, Wertz CJ, Suelzer EM, Arbogast KB, Meier TB. Advanced biomarkers of pediatric mild traumatic brain injury: Progress and perils. Neurosci Biobehav Rev 2018; 94:149-165. [PMID: 30098989 DOI: 10.1016/j.neubiorev.2018.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
There is growing public concern about neurodegenerative changes (e.g., Chronic Traumatic Encephalopathy) that may occur chronically following clinically apparent and clinically silent (i.e., sub-concussive blows) pediatric mild traumatic brain injury (pmTBI). However, there are currently no biomarkers that clinicians can use to objectively diagnose patients or predict those who may struggle to recover. Non-invasive neuroimaging, electrophysiological and neuromodulation biomarkers have promise for providing evidence of the so-called "invisible wounds" of pmTBI. Our systematic review, however, belies that notion, identifying a relative paucity of high-quality, clinically impactful, diagnostic or prognostic biomarker studies in the sub-acute injury phase (36 studies on unique samples in 28 years), with the majority focusing on adolescent pmTBI. Ultimately, well-powered longitudinal studies with appropriate control groups, as well as standardized and clearly-defined inclusion criteria (time post-injury, injury severity and past history) are needed to truly understand the complex pathophysiology that is hypothesized (i.e., still needs to be determined) to exist during the acute and sub-acute stages of pmTBI and may underlie post-concussive symptoms.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States; Neurology Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, NM, 87131, United States; Psychology Department, University of New Mexico, Albuquerque, NM, 87131, United States.
| | - Mayank Kaushal
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Faith M Hanlon
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Nicholas A Shaff
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, 02115, United States
| | - Christina L Master
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States; Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, United States
| | - John J Leddy
- UBMD Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo, NY, 14214, United States
| | - David Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Christopher J Wertz
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Pete & Nancy Domenici Hall, 1011 Yale Blvd. NE, Albuquerque, NM, 87106, United States
| | - Elizabeth M Suelzer
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, PA, 19104, United States
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, 53226, United States; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, 53226, United States
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48
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Effects of Mild Blast Traumatic Brain Injury on Cognitive- and Addiction-Related Behaviors. Sci Rep 2018; 8:9941. [PMID: 29967344 PMCID: PMC6028456 DOI: 10.1038/s41598-018-28062-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/07/2018] [Indexed: 12/30/2022] Open
Abstract
Traumatic brain injury (TBI) commonly results in cognitive and psychiatric problems. Cognitive impairments occur in approximately 30% of patients suffering from mild TBI (mTBI), and correlational evidence from clinical studies indicates that substance abuse may be increased following mTBI. However, understanding the lasting cognitive and psychiatric problems stemming from mTBI is difficult in clinical settings where pre-injury assessment may not be possible or accurate. Therefore, we used a previously characterized blast model of mTBI (bTBI) to examine cognitive- and addiction-related outcomes. We previously demonstrated that this model leads to bilateral damage of the medial prefrontal cortex (mPFC), a region critical for cognitive function and addiction. Rats were exposed to bTBI and tested in operant learning tasks several weeks after injury. bTBI rats made more errors during acquisition of a cue discrimination task compared to sham treated rats. Surprisingly, we observed no differences between groups in set shifting and delayed matching to sample, tasks known to require the mPFC. Separate rats performed cocaine self-administration. No group differences were found in intake or extinction, and only subtle differences were observed in drug-primed reinstatement 3-4 months after injury. These findings indicate that bTBI impairs acquisition of a visual discrimination task and that bTBI does not significantly increase the ability of cocaine exposure to trigger drug seeking.
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49
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Coyle HL, Ponsford J, Hoy KE. Understanding individual variability in symptoms and recovery following mTBI: A role for TMS-EEG? Neurosci Biobehav Rev 2018; 92:140-149. [PMID: 29885426 DOI: 10.1016/j.neubiorev.2018.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 05/15/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022]
Abstract
The pathophysiology associated with mild traumatic brain injury (mTBI) includes neurometabolic and cytoskeletal changes that have been shown to impair structural and functional connectivity. Evidence that persistent neuropsychological impairments post injury are linked to structural and functional connectivity changes is increasing. However, to date the relationship between connectivity changes, heterogeneity of persistent symptoms and recovery post mTBI has been poorly characterised. Recent innovations in neuroimaging provide new ways of exploring connectivity changes post mTBI. Namely, combined transcranial magnetic stimulation and electroencephalography (TMS-EEG) offers several advantages over traditional approaches for studying connectivity changes post TBI. Its ability to perturb neural function in a controlled manner allows for measurement of causal interactions or effective connectivity between brain regions. We review the current literature assessing structural and functional connectivity following mTBI and outline the rationale for the use of TMS-EEG as an ideal tool for investigating the neural substrates of connectivity dysfunction and reorganisation post mTBI. The diagnostic, prognostic and potential therapeutic implications will also be explored.
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Affiliation(s)
- Hannah L Coyle
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Central Clinical School, Melbourne, Australia.
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton, Australia
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Central Clinical School, Melbourne, Australia
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50
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Meconi A, Wortman RC, Wright DK, Neale KJ, Clarkson M, Shultz SR, Christie BR. Repeated mild traumatic brain injury can cause acute neurologic impairment without overt structural damage in juvenile rats. PLoS One 2018; 13:e0197187. [PMID: 29738554 PMCID: PMC5940222 DOI: 10.1371/journal.pone.0197187] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/27/2018] [Indexed: 11/19/2022] Open
Abstract
Repeated concussion is becoming increasingly recognized as a serious public health concern around the world. Moreover, there is a greater awareness amongst health professionals of the potential for repeated pediatric concussions to detrimentally alter the structure and function of the developing brain. To better study this issue, we developed an awake closed head injury (ACHI) model that enabled repeated concussions to be performed reliably and reproducibly in juvenile rats. A neurological assessment protocol (NAP) score was generated immediately after each ACHI to help quantify the cumulative effects of repeated injury on level of consciousness, and basic motor and reflexive capacity. Here we show that we can produce a repeated ACHI (4 impacts in two days) in both male and female juvenile rats without significant mortality or pain. We show that both single and repeated injuries produce acute neurological deficits resembling clinical concussion symptoms that can be quantified using the NAP score. Behavioural analyses indicate repeated ACHI acutely impaired spatial memory in the Barnes maze, and an interesting sex effect was revealed as memory impairment correlated moderately with poorer NAP score performance in a subset of females. These cognitive impairments occurred in the absence of motor impairments on the Rotarod, or emotional changes in the open field and elevated plus mazes. Cresyl violet histology and structural magnetic resonance imaging (MRI) indicated that repeated ACHI did not produce significant structural damage. MRI also confirmed there was no volumetric loss in the cortex, hippocampus, or corpus callosum of animals at 1 or 7 days post-ACHI. Together these data indicate that the ACHI model can provide a reliable, high throughput means to study the effects of concussions in juvenile rats.
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Affiliation(s)
- Alicia Meconi
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Ryan C. Wortman
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - David K. Wright
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Katie J. Neale
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Melissa Clarkson
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Sandy R. Shultz
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Brian R. Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
- Centre for Brain Health and Program in Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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