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Wizner K, Journeay WS, Jolivet D, Ahle J. Mild traumatic brain injury caused by workplace violence in a US workers' compensation system. Occup Environ Med 2024; 81:395-399. [PMID: 38981678 DOI: 10.1136/oemed-2024-109437] [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: 01/22/2024] [Accepted: 05/21/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES Approximately 81% of traumatic brain injury cases are considered to be mild (mTBI), but few studies have reviewed mTBI caused by workplace violence (WPV). This study aimed to (1) determine the incidence of mTBI secondary to WPV in a statewide workers' compensation system using International Classification of Disease codes and (2) analyse and compare factors associated with return-to-work outcomes between WPV mTBI cases versus other mechanisms. METHODS Using a retrospective cohort of claims data from the California Workers' Compensation Information System during 2015-2019, cases with a return-to-work date were classified as WPV if the injury description contained keywords such as assault, gunpoint, harassed, intimidated, punch, threat, robbery, violent or verbal abuse. RESULTS Of the 14 089 mTBI claims analysed in this study, 11.2% were caused by WPV. When comparing WPV to non-WPV claims, the variables with statistically significant (p≤0.001) differences were age, income, industry and job class. There were no significant differences between groups for leave duration. In a linear mixed model, the variable of interest (WPV) was not associated with recovery duration after adjusting for other factors. CONCLUSION To our knowledge, this is the first study to examine WPV mTBI claims in the USA. The findings suggest that the public administration, education and healthcare and social services industries are at higher risk for WPV mTBI. WPV and job class were the only modifiable factors in the model and therefore should be the focus of additional research.
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Affiliation(s)
| | - W Shane Journeay
- Departments of Medicine and Community Health & Epidemiology, Dalhousie Medicine New Brunswick, Dalhousie University, Saint John, New Brunswick, Canada
- Department of Medicine, Division of Physical Medicine & Rehabilitation, Dalhousie University, Saint John, New Brunswick, Canada
- Providence Healthcare - Unity Health Toronto, Toronto, Ontario, Canada
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Sansonetti D, Fleming J, Patterson F, De Lacy L, Lannin NA. Factors associated with self-awareness impairment in an inpatient brain injury rehabilitation cohort. Brain Inj 2024; 38:699-707. [PMID: 38634476 DOI: 10.1080/02699052.2024.2344096] [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: 01/29/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Self-awareness impairment is common following acquired brain injury and can impact rehabilitation outcomes. Knowledge of factors associated with impaired self-awareness may assist with rehabilitation planning. OBJECTIVES To identify factors associated with self-awareness and determine predictors of self-awareness impairment for adults with traumatic brain injury (TBI) and stroke. DESIGN AND METHODS A retrospective cohort study of rehabilitation inpatients was conducted by medical record audit. Self-awareness was measured using the Self-awareness of Deficits Interview (SADI). Relationships between SADI scores and demographic and clinical variables were identified with non-parametric statistics. Predictors of SADI scores were identified using ordinal regression analyses for TBI and stroke groups. RESULTS Participants were 149 adults (18-70 years) with TBI (n = 110) and stroke (n = 39). For TBI, longer post-traumatic amnesia (PTA), lower functional cognition/communication, and behaviors of concern (BoC) were significantly associated with higher SADI scores (i.e. impaired self-awareness). For stroke, lower functional cognition/communication and motor scores were associated with higher SADI scores. Impaired self-awareness was predicted by PTA duration, acute length of stay and presence of BoC for the TBI group, and by functional cognition/communication for the stroke group. CONCLUSION Different factors were associated with impaired self-awareness for individuals with TBI and stroke during inpatient rehabilitation.
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Affiliation(s)
- Danielle Sansonetti
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Freyr Patterson
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Laura De Lacy
- Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia
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Karcz K, Schwegler U, Schiffmann B, Finger ME. Risk factors and service gaps affecting a sustainable work: a qualitative multi-stakeholder analysis in the context of persons with acquired brain injury living in Switzerland. BMC Health Serv Res 2024; 24:753. [PMID: 38902701 PMCID: PMC11188514 DOI: 10.1186/s12913-024-11128-3] [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: 05/23/2023] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Along with the social and economic challenges posed by an aging society, creating work conditions that allow persons to stay healthy and work into old age has become a major task of Western societies. Retaining employment after returning to work is particularly difficult for individuals with a disability, as evidenced by the high rate of premature labor market dropout. Individuals with acquired brain injury (ABI) exemplify this challenge, as it often impairs cognitive, technical, and interpersonal abilities that are crucial in today's labor market. To effectively support these individuals, vocational integration practitioners require comprehensive knowledge of risk factors for premature labor market dropout and effective strategies for sustainable work. OBJECTIVE This study aimed to identify perceived risk factors and related service gaps regarding sustainable work for people with ABI, as reported by affected individuals, employers, vocational integration professionals, and health professionals. METHODS Secondary data analysis. Data that was originally collected through seven focus groups and two interviews with persons with ABI, 15 interviews with employers, and 13 interviews with vocational integration and health professionals in the context of the project 'Sustainable employment' was re-analysed thematically. RESULTS Two major themes of risk factors were identified: (1) person-related factors (including the subthemes: post-ABI impairments; lack of understanding of post-ABI impairments; poor health management) and (2) environment-related factors (including the subthemes: challenges related to the service structure; insufficient knowledge and education about ABI; challenges at the workplace; difficulties in private life). While stakeholders noted the variety of the currently available services, they particularly pointed to the missing long-term monitoring and counseling services for persons with ABI following the initial return-to-work, reflecting a major challenge for sustainable work. An overarching gap related to the fragmentation of the service structure and the lack of case coordination along the working life. CONCLUSIONS Multiple stakeholders emphasized the importance of empowering individuals, ensuring easy access to professional support, and providing a suitable work environment to address key risk factors and facilitate sustainable work for individuals with ABI. Continuous coaching, long-term monitoring and counseling following return-to-work, were identified as potential strategies to achieve these goals.
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Affiliation(s)
- Katarzyna Karcz
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil, 6207, Switzerland.
| | - Urban Schwegler
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil, 6207, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Barbara Schiffmann
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil, 6207, Switzerland
| | - Monika E Finger
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, Nottwil, 6207, Switzerland
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Aliaga Á, Bracho MJ, Romero M, Saldías MJ, Jofré X, Salas C. The contribution of executive functions to the process of return to work after brain injury: A systematic review. Neuropsychol Rehabil 2024; 34:619-648. [PMID: 37427841 DOI: 10.1080/09602011.2023.2224031] [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: 08/12/2022] [Accepted: 06/02/2023] [Indexed: 07/11/2023]
Abstract
Acquired brain injury (ABI) is a worldwide public health issue for its high prevalence rate and the disability it produces. The consequences of ABI, including cognitive deficits, may impact return to work. This review focuses on the association between executive functions (EFs) and return to work after ABI. A systematic review of the literature between 1998 and 2023 was conducted following PRISMA guidelines. The articles were retrieved from the Pubmed, Medline and Web of Science databases. A total of 49 studies were finally selected. Impairments of EF were consistently shown to have a negative impact on return to work after an ABI. There is evidence that specific executive functions and neurobehavioral variables may affect return to work Studies showed a significant theoretical and methodological heterogeneity, representing an important limitation to understand the relation between EFs and work. There is a robust association between EFs and return to work after brain injury. Findings in this systematic review raise the need for further research on the role of specific EF profiles in the process of returning to work after brain damage.
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Affiliation(s)
- Álvaro Aliaga
- Unidad de Neuropsicología Clínica, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | | | - Matías Romero
- Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | | | - Ximena Jofré
- Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
| | - Christian Salas
- Unidad de Neuropsicología Clínica, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Centro de Neurociencia Humana y Neuropsicología (CENHN), Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
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de Geus EQJ, Milders MV, van Horn JE, Jonker FA, Fassaert T, Hutten JC, Kuipers F, Grimbergen C, Noordermeer SDS. A literature review of outcome and treatment options after acquired brain injury: Suggestions for adult offenders using knowledge from the general population. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:311-338. [PMID: 38527155 DOI: 10.1002/cbm.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Acquired brain injury (ABI) is a major health problem, often with negative effects on behaviour and mental health as well as cognition. Prevalence of ABI is exceptionally high among offenders and increases their re-offending risk. Information on risk factors for ABI and its outcomes among offenders that could guide effective treatment for them is, nevertheless, scarce and dispersed. However, there is a more substantial literature about the general population that could inform work with brain-injured offenders, especially when selecting for samples or subgroups with similar relevant characteristics, such as lower socio-economic status (SES), pre-injury lower tested intelligence score (<85) and pre-injury mental health problems. AIMS To explore brain injury data from non-offender samples of otherwise similar socio-economic and mental health and ability characteristics to offenders then, first, to describe their untreated outcomes and, secondly, outcomes after frequently used interventions in these circumstances, noting factors associated with their effectiveness. METHOD Three databases were systematically searched for the years 2010-2022; first, using terms for brain injury or damage and cognitive (dys)function, mental health or quality of life. Second, in a separate search, we used these terms and terms for interventions and rehabilitation. In the second review, studies were selected for clear, distinguishable data on age, sex, SES and lifestyle factors to facilitate inferences for offenders. A narrative analytical approach was adopted for both reviews. RESULTS Samples with characteristics that are typical in offender groups, including lower SES, lower pre-injury intelligence quotient (<85), prior cognitive impairments and prior mental health problems, had poorer cognitive and behavioural outcomes following ABI than those without such additional problems, together with lower treatment adherence. With respect to treatment, adequate motivation and self-awareness were associated with better cognitive and behavioural outcomes than when these were low or absent, regardless of the outcome measured. CONCLUSIONS More complex pre-injury mental health problems and social disadvantages typical of offenders are associated with poorer post-brain injury recovery. This paper adds to practical knowledge by bringing together work that follows specific outcome trajectories. Overall, succesful ABI-interventions in the general population that aim at pre-injury difficulties comparable to those seen among offenders, show that personalising injury-specific treatments and taking account of these difficulties, maximised positive outcomes.
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Affiliation(s)
- Esther Q J de Geus
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maarten V Milders
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Frank A Jonker
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Altrecht, Vesalius, Amsterdam, The Netherlands
| | | | | | | | | | - Siri D S Noordermeer
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Hendryckx C, Couture M, Gosselin N, Nalder E, Gagnon-Roy M, Thibault G, Bottari C. A window into the reality of families living long term with challenging behaviours after a TBI. Neuropsychol Rehabil 2024:1-32. [PMID: 38781592 DOI: 10.1080/09602011.2024.2354402] [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: 12/01/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
Challenging behaviours are a long-term burden for people with traumatic brain injury (TBI) and their families. Families frequently shoulder the responsibility alone, but little is known about the strategies they use to manage these behaviours. This study aimed to 1) identify the coping strategies used by people with TBI living in the community and their family caregivers to manage challenging behaviours; and 2) describe the similarities and differences between strategies used by people with TBI and caregivers. In this qualitative descriptive design, individual semi-structured interviews were conducted with adults with TBI and their caregivers and were inductively analyzed. The sample included 10 dyads and two triads, totalling 12 caregivers (8 women) and 14 individuals with TBI (6 women; 21.71 ± 10.84 years post-injury). Participants' strategies were proactive (prevention), reactive (response), or retroactive (aftercare). Most strategies were described by caregivers. Some of them were effective and lasting, others not, reflecting how they adapted their approaches over time. Families put in place various strategies in their life's journey, such as giving feedback or adapting the environment. Despite these strategies supporting long-term community living, the need for ongoing support is underscored, as crises may still occur, impacting families' quality of life.
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Affiliation(s)
- Charlotte Hendryckx
- Department of Psychology, Université de Montréal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Center for Advanced Research in Sleep Medicine (CEAMS), Hôpital du Sacré-Cœur de Montréal, CIUSSS NIM Research Center, Montreal, Canada
| | - Mélanie Couture
- Centre for research and expertise in social gerontology (CREGÉS), CIUSSS West-Central Montreal, Côte Saint-Luc, Canada
- École de travail social, Faculté des lettres et sciences humaines, Université de Sherbrooke, Sherbrooke, Canada
| | - Nadia Gosselin
- Department of Psychology, Université de Montréal, Montreal, Canada
- Center for Advanced Research in Sleep Medicine (CEAMS), Hôpital du Sacré-Cœur de Montréal, CIUSSS NIM Research Center, Montreal, Canada
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Mireille Gagnon-Roy
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Occupational Therapy program, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Geneviève Thibault
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Service québécois d'expertise en troubles graves du comportement (SQETGC), CIUSSS MCQ, Montréal, Canada
| | - Carolina Bottari
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Occupational Therapy program, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada
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Hendryckx C, Couture M, Gosselin N, Nalder E, Gagnon-Roy M, Thibault G, Bottari C. The dual reality of challenging behaviours: Overlapping and distinct perspectives of individuals with TBI and their caregivers. Neuropsychol Rehabil 2024; 34:485-509. [PMID: 37219424 DOI: 10.1080/09602011.2023.2212172] [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: 12/08/2022] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
Challenging behaviours significantly impact the lives of people with traumatic brain injury (TBI) and their family caregivers. However, these behaviours are rarely defined from the perspectives of both individuals, a necessary step to developing interventions targeting meaningful goals for individuals and caregivers. This study aimed to (1) explore and confirm the perspective of individuals with TBI living in the community and their family caregivers on behaviours they consider challenging and, (2) identify overlapping or distinct views on challenging behaviours. A qualitative descriptive design was used. Twelve caregivers (8 females; 59.67 ± 11.64 years old) and 14 participants with mild-severe TBI (6 females; 43.21 ± 10.98 years old; time post-injury: 21.71 ± 10.84 years) were interviewed (10 dyads and two triads). Data were analysed using inductive qualitative analysis. Challenging behaviours most frequently reported by all participants were aggressive/impulsive behaviours, inappropriate social behaviours, and behavioural manifestations of cognitive impairments. Overlapping perspectives were identified regarding aggressive behaviours. Distinctions exist as inappropriate social behaviours and cognitive difficulties were mainly reported by caregivers. Our results confirm that perspectives may vary between dyad members. Interventions should include dyad inputs to formulate goals that are significant to the person with TBI and their caregiver.
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Affiliation(s)
- Charlotte Hendryckx
- Department of Psychology, Université de Montréal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- Center for Advanced Research in Sleep Medicine (CEAMS), Hôpital du Sacré-Coeur de Montréal, Centre de recherche du CIUSSS NIM, Montreal, Canada
| | - Mélanie Couture
- Centre for research and expertise in social gerontology (CREGÉS), CIUSSS West-Central Montreal, Côte Saint-Luc, Canada
- École de travail social, Faculté des lettres et sciences humaines, Université de Sherbrooke, Sherbrooke, Canada
| | - Nadia Gosselin
- Department of Psychology, Université de Montréal, Montreal, Canada
- Center for Advanced Research in Sleep Medicine (CEAMS), Hôpital du Sacré-Coeur de Montréal, Centre de recherche du CIUSSS NIM, Montreal, Canada
| | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Mireille Gagnon-Roy
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- School of RehabilitationUniversité de Montréal, Montreal, Canada
| | - Geneviève Thibault
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montreal, Canada
- Service québécois d'expertise en troubles graves du comportement (SQETGC), CIUSSS MCQ, Montreal, Canada
| | - Carolina Bottari
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal (CRIR), Montreal, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux (CIUSSS) Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- School of RehabilitationUniversité de Montréal, Montreal, Canada
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Halalmeh DR, Salama HZ, LeUnes E, Feitosa D, Ansari Y, Sachwani-Daswani GR, Moisi MD. The Role of Neuropsychology in Traumatic Brain Injury: Comprehensive Literature Review. World Neurosurg 2024; 183:128-143. [PMID: 38104936 DOI: 10.1016/j.wneu.2023.12.069] [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: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Traumatic brain injury (TBI) is a major public health concern, often leading to significant behavioral and cognitive changes with subsequent impairment in daily functioning and personal interactions. The management of TBI involves a multidisciplinary approach. Neuropsychology has emerged as a critical discipline in assessing, diagnosing, treating, and rehabilitating individuals with TBI. Successful management also requires careful consideration of the patient's cognitive status. Therefore, clinicians must have a comprehensive understanding of the overall clinical picture of the patient at the cognitive and physical level. The primary aim of this research is to explore the role of neuropsychology in TBI management and rehabilitation thoroughly while providing an updated review of the literature. Various neuropsychological assessment tools used to evaluate cognitive functioning in individuals with TBI will be discussed in addition to their validity, reliability, and usefulness in identifying cognitive deficits and developing individualized treatment plans. The findings in this article will have significant implications on the clinical practice of neuropsychology in TBI patients, highlighting the importance of neuropsychological assessment in optimizing the management of this population. The need for increased awareness of neuropsychology among health care professionals, especially in the acute hospital setting, is growing along with the increase in diagnosis of TBI and its complications. Adequate understanding of the complex interplay between cognitive, emotional, and behavioral factors in TBI can inform the development of new interventions and treatment strategies, making it equally as important for patients and their families.
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Affiliation(s)
- Dia R Halalmeh
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA; Department of Surgery, Michigan State University-College of Human Medicine, Traverse City, Michigan, USA; Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, Michigan, USA.
| | | | - Emma LeUnes
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
| | - David Feitosa
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
| | - Yusuf Ansari
- Temple University, Philadelphia, Pennsylvania, USA
| | - Gul R Sachwani-Daswani
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, Michigan, USA
| | - Marc D Moisi
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA; Department of Surgery, Michigan State University-College of Human Medicine, Traverse City, Michigan, USA; Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, Michigan, USA
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Anderson JFI, Higson L, Wu MH, Seal ML, Yang JYM. Cerebral microhaemorrhage count is related to processing speed, but not level of symptom reporting, independently of age, psychological status and premorbid functioning, after first-ever mild traumatic brain injury. Brain Imaging Behav 2023; 17:608-618. [PMID: 37386315 PMCID: PMC10733206 DOI: 10.1007/s11682-023-00788-0] [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] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
Cerebral microhaemorrhage is a commonly identified neuropathological consequence of mild traumatic brain injury (mTBI) and can be identified in vivo using susceptibility weighted imaging (SWI). This study aimed to determine whether SWI-detected microhaemorrhages are more common in individuals after a single, first-ever, mTBI event relative to trauma controls (TC) and to investigate whether a linear relationship exists between microhaemorrhage numbers and cognition or symptom reporting in the post-acute period after injury, independently of age, psychological status and premorbid level of functioning. Microhaemorrhagic lesions were identified by expert clinical examination of SWI for 78 premorbidly healthy adult participants who were admitted to hospital after a traumatic injury and had suffered a first-ever mTBI (n = 47) or no head strike (n = 31). Participants underwent objective cognitive examination of processing speed, attention, memory, and executive function as well as self-reported post-concussion symptomatology. Bootstrapping analyses were used as data were not normally distributed. Analyses revealed that the mTBI group had significantly more microhaemorrhages than the TC group (Cohen's d = 0.559). These lesions were only evident in 28% of individuals. The mTBI participants demonstrated a significant linear association between number of microhaemorrhages and processing speed, independently of age, psychological status, or premorbid level of functioning. This study shows that a single mTBI causes cerebral microhaemorrhages to occur in a minority of premorbidly healthy individuals. Greater microhaemorrhage count is independently associated with slower processing speed, but not symptom reporting, during the post-acute injury period.
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Affiliation(s)
- Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
- Psychology Department, The Alfred hospital, Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Lana Higson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Michelle H Wu
- Medical Imaging, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia
| | - Marc L Seal
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Neuroscience research, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
- Neuroscience Advanced Clinical Imaging Service (NACIS), Department of Neurosurgery, The Royal Children's Hospital, Melbourne, VIC, 3052, Australia
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10
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Green REA, Dabek MK, Changoor A, Rybkina J, Monette GA, Colella B. Moderate-Severe TBI as a Progressive Disorder: Patterns and Predictors of Cognitive Declines in the Chronic Stages of Injury. Neurorehabil Neural Repair 2023; 37:799-809. [PMID: 37990972 DOI: 10.1177/15459683231212861] [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: 11/23/2023]
Abstract
BACKGROUND Moderate-severe traumatic brain injury (TBI) has been associated with progressive cognitive decline in the chronic injury stages in a small number of studies. OBJECTIVE This study aimed to (i) replicate our previous findings of decline from 1 to 3+ years post-injury in a larger, non-overlapping sample and (ii) extend these findings by examining the proportion of decliners in 2 earlier time windows, and by investigating novel predictors of decline. METHODS N = 48 patients with moderate-severe TBI underwent neuropsychological assessment at 2, 5, 12 months, and 30+ months post-injury. We employed the Reliable Change Index (RCI) to evaluate decline, stability and improvement across time and logistic regression to identify predictors of decline (demographic/cognitive reserve; injury-related). RESULTS The proportions of patients showing decline were: 12.5% (2-5 months post-injury), 17% (5-12 months post-injury), and 27% (12-30+ months post-injury). Measures of verbal retrieval were most sensitive to decline. Of the predictors, only left progressive hippocampal volume loss from 5 to 12 months post-injury significantly predicted cognitive decline from 12 to 30+ months post-injury. CONCLUSIONS Identical to our previous study, 27% of patients declined from 12 to 30+ months post-injury. Additionally, we found that the further from injury, the greater the proportion of patients declining. Importantly, earlier progressive hippocampal volume loss predicted later cognitive decline. Taken together, the findings highlight the need for ongoing research and treatment that target these deleterious mechanisms affecting patients in the chronic stages of moderate-severe TBI.
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Affiliation(s)
- Robin E A Green
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Marika K Dabek
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Alana Changoor
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Julia Rybkina
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Brenda Colella
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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11
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Aadal L, Hundborg MO, Pallesen H, Steensgaard R. A meaningful everyday life experienced by adults with acquired neurological impairments: A scoping review. PLoS One 2023; 18:e0286928. [PMID: 37878623 PMCID: PMC10599513 DOI: 10.1371/journal.pone.0286928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/25/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This scoping review explores the characteristics of a meaningful life appraised by adults living with an acquired neurological impairment. INTRODUCTION Limitations in function, activity or participation following a neurological injury or disease imposes comprehensive changes on the every-day life of the affected person and close relatives. Including patients' perception of a meaningful life is pivotal to facilitate motivation and individualize rehabilitation efforts to address the patients' wishes, hopes, needs, and preferences. Surprisingly, only little research has been devoted to illuminating what a meaningful life is from the impaired person's perspective. Hence, a scoping review of existing knowledge is needed to facilitate person-centered high-quality rehabilitation and research initiatives. INCLUSION CRITERIA All studies, published in English or Scandinavian languages describing a meaningful life as experienced by adult persons with neurological impairment were included. No search date range filter was selected. METHODS This review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews according to a published protocol. A three-step search strategy was conducted in the databases PubMed, Cinahl, PsycINFO and Embase. At least two independent researchers conducted inclusions and exclusions, data extraction, and analyses. Covidence software was used to manage the information. FINDINGS We identified 307 studies. Of these, 20 were included and quality assessed. Findings are reported in accordance with the PRISMA- SCR checklist and descriptively presented mapped in three main domains and 10 ten sub-domains. CONCLUSION Current literature conveys no clear definition or perception of what a meaningful life is. However, across the 20 included studies, the following main characteristics were stepped forward as particularly significant for adults living with an acquired neurological impairment in regard to achieving a meaningful life: i) to be part of meaningful relationships and meaningful activities; ii) to become confident with one's perceived identity.
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Affiliation(s)
- Lena Aadal
- Hammel Neurorehabilitation Centre and University Research Clinic, Regional Hospital Central Jutland, Hammel, Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | | | - Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, Regional Hospital Central Jutland, Hammel, Denmark
| | - Randi Steensgaard
- Specialized Hospital for Polio and Accident Victims, Aarhus, Denmark
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12
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Anderson JFI, Oehr LE, Chen J, Maller JJ, Seal ML, Yang JYM. The relationship between cognition and white matter tract damage after mild traumatic brain injury in a premorbidly healthy, hospitalised adult cohort during the post-acute period. Front Neurol 2023; 14:1278908. [PMID: 37936919 PMCID: PMC10626495 DOI: 10.3389/fneur.2023.1278908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/21/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Recent developments in neuroimaging techniques enable increasingly sensitive consideration of the cognitive impact of damage to white matter tract (WMT) microstructural organisation after mild traumatic brain injury (mTBI). Objective This study investigated the relationship between WMT microstructural properties and cognitive performance. Participants setting and design Using an observational design, a group of 26 premorbidly healthy adults with mTBI and a group of 20 premorbidly healthy trauma control (TC) participants who were well-matched on age, sex, premorbid functioning and a range of physical, psychological and trauma-related variables, were recruited following hospital admission for traumatic injury. Main measures All participants underwent comprehensive unblinded neuropsychological examination and structural neuroimaging as outpatients 6-10 weeks after injury. Neuropsychological examination included measures of speed of processing, attention, memory, executive function, affective state, pain, fatigue and self-reported outcome. The WMT microstructural properties were estimated using both diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) modelling techniques. Tract properties were compared between the corpus callosum, inferior longitudinal fasciculus, uncinate fasciculus, anterior corona radiata and three segmented sections of the superior longitudinal fasciculus. Results For the TC group, in all investigated tracts, with the exception of the uncinate fasciculus, two DTI metrics (fractional anisotropy and apparent diffusion coefficient) and one NODDI metric (intra-cellular volume fraction) revealed expected predictive linear relationships between extent of WMT microstructural organisation and processing speed, memory and executive function. The mTBI group showed a strikingly different pattern relative to the TC group, with no relationships evident between WMT microstructural organisation and cognition on most tracts. Conclusion These findings indicate that the predictive relationship that normally exists in adults between WMT microstructural organisation and cognition, is significantly disrupted 6-10 weeks after mTBI and suggests that WMT microstructural organisation and cognitive function have disparate recovery trajectories.
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Affiliation(s)
- Jacqueline F. I. Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Lucy E. Oehr
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Jian Chen
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Jerome J. Maller
- General Electric Healthcare, Melbourne, VIC, Australia
- Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Marc L. Seal
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Joseph Yuan-Mou Yang
- Developmental Imaging, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Neuroscience Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, Neuroscience Advanced Clinical Imaging Service (NACIS), The Royal Children's Hospital, Melbourne, VIC, Australia
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13
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Chua AE, Yacapin VJ, Manalo GL, Ledesma LK. Protocol for Safety and Efficacy of MLC901 (NeuroAiD II) in Patients With Moderate Traumatic Brain Injury: A Randomized Double-Blind Placebo-Controlled Trial (ANDROMEDA). Neurosurgery 2023; 93:939-951. [PMID: 37129384 DOI: 10.1227/neu.0000000000002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic brain injury (TBI) remains a leading cause of death and disability, affecting approximately 69 million individuals each year worldwide. A significant portion of TBI research has focused on treatments for neuroprotection and/or neurorecovery, with most failing to transition to successful clinical applications despite promising animal/in vitro study results. MLC901 (NeuroAiD II), with origins from a traditional Chinese medicine, has been shown to exhibit both neuroprotective and neuroregenerative properties in in vitro and animal studies for stroke and TBI. Clinical trials have demonstrated its safety with significant improvements in some functional outcome and cognitive domain measures. The objective of this study is to determine the efficacy and safety of MLC901 (NeuroAiD II) vs placebo in adult patients with moderate TBI. METHODS This is a multicenter randomized double-blind placebo-controlled trial that aims to enroll 120 adult patients with moderate TBI receiving standard of care in 2 arms: MLC901 vs placebo for a treatment period of 6 months with a further follow-up of 3 months. The total duration of the study is 9 months. The primary end point is Glasgow Outcome Scale Extended (GOS-E) at 6 months. Other assessments include mortality at 6 months, GOS-E, Glasgow Coma Scale, Montreal Cognitive Assessment Filipino Version, Frontal Assessment Battery Conflicting Instructions and Go-No-Go, Rivermead Post-Concussion Symptom Questionnaire, Barthel Index, Hospital Anxiety and Depression Scale, and Health related Quality of life (EQ-5D) at 1, 3, 6, and 9 months. Cerebral swelling at baseline and at 1 and 2 weeks will also be documented. Adverse events and drug compliance will also be monitored. EXPECTED OUTCOMES We expect to find a significant improvement in functional and cognitive outcomes in patients who were given MLC901. DISCUSSION Previous studies on the effect of MLC901 in adult patients with moderate TBI showed positive results; However, these studies are limited by the small number of patients. This study will establish a more definitive role of MLC901 in improving functional and cognitive outcomes in patients with moderate TBI.
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Affiliation(s)
- Annabell E Chua
- Division of Neurosurgery, University of the Philippines-Philippine General Hospital, Manila , Philippines
| | - Vilma Jane Yacapin
- Section of Neurosurgery, Department of Surgery, Northern Mindanao Medical Center, Cagayan de Oro City , Misamis Oriental , Philippines
| | - Guillermo L Manalo
- Department of Internal Medicine, Mariano Marcos Memorial Hospital & Medical Center, Batac City , Ilocos Norte , Philippines
| | - Lourdes K Ledesma
- Department of Neurosciences, Section of Adult Neurology, Makati Medical Center, Makati , Philippines
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14
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Libeson L, Ross P, Downing M, Ponsford J. Development and feasibility testing of a psychoeducational tool to support the return to work (RTW) of individuals with traumatic brain injury (TBI): The RTW after TBI app. Neuropsychol Rehabil 2023; 33:1349-1367. [PMID: 35838987 DOI: 10.1080/09602011.2022.2097928] [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: 10/28/2021] [Accepted: 06/29/2022] [Indexed: 10/17/2022]
Abstract
To document the development and clinician evaluation of a psychoeducational and support tool: the return to work after traumatic brain injury app (RTW after TBI app). Co-design of the app involved the collaboration of traumatic brain injury (TBI) /vocational rehabilitation (VR) expert researchers (n = 4) and lived experience co-designers (individuals with TBI who had previously returned to work; n = 4). Twelve TBI/VR clinician reviewers then evaluated the app. Content analysis of TBI/VR clinician reviewers' interviews revealed four themes: content, usability (functional ease of use), utility (applicability to RTW after TBI) and suggestions for improvements. All clinicians reported that they would use the RTW after TBI app in their clinical practice. Although several aspects were reported to potentially limit the app's appropriateness for some TBI clients, many feasible improvements were suggested to address limitations. These improvements aim to increase the utility of the app with a wider range of clients and extend its use to other settings. Future research should evaluate, in a clinical trial, the efficacy of the RTW after TBI app in supporting individuals with TBI and their vocational providers and optimizing RTW success.
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Affiliation(s)
- Lauren Libeson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Pamela Ross
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
- Epworth HealthCare, Richmond, Australia
| | - Marina Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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15
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Turkstra LS, Hosseini-Moghaddam S, Wohltjen S, Nurre SV, Mutlu B, Duff MC. Facial affect recognition in context in adults with and without TBI. Front Psychol 2023; 14:1111686. [PMID: 37645059 PMCID: PMC10461638 DOI: 10.3389/fpsyg.2023.1111686] [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: 11/29/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Several studies have reported impaired emotion recognition in adults with traumatic brain injury (TBI), but studies have two major design features that limit application of results to real-world contexts: (1) participants choose from among lists of basic emotions, rather than generating emotion labels, and (2) images are typically presented in isolation rather than in context. To address these limitations, we created an open-labeling task with faces shown alone or in real-life scenes, to more closely approximate how adults with TBI label facial emotions beyond the lab. Methods Participants were 55 adults (29 female) with moderate to severe TBI and 55 uninjured comparison peers, individually matched for race, sex, and age. Participants viewed 60 photographs of faces, either alone or in the pictured person's real-life context, and were asked what that person was feeling. We calculated the percent of responses that were standard forced-choice-task options, and also used sentiment intensity analysis to compare verbal responses between the two groups. We tracked eye movements for a subset of participants, to explore whether gaze duration or number of fixations helped explain any group differences in labels. Results Over 50% of responses in both groups were words other than basic emotions on standard affect tasks, highlighting the importance of eliciting open-ended responses. Valence of labels by participants with TBI was attenuated relative to valence of Comparison group labels, i.e., TBI group responses were less positive to positive images and the same was true for negative images, although the TBI group responses had higher lexical diversity. There were no significant differences in gaze duration or number of fixations between groups. Discussion Results revealed qualitative differences in affect labels between adults with and without TBI that would not have emerged on standard forced-choice tasks. Verbal differences did not appear to be attributable to differences in gaze patterns, leaving open the question of mechanisms of atypical affect processing in adults with TBI.
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Affiliation(s)
- Lyn S. Turkstra
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Sophie Wohltjen
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Sara V. Nurre
- American Speech-Language-Hearing Association, Rockville, MD, United States
| | - Bilge Mutlu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, United States
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16
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Wong KR, Wright DK, Sgro M, Salberg S, Bain J, Li C, Sun M, McDonald SJ, Mychasiuk R, Brady RD, Shultz SR. Persistent Changes in Mechanical Nociception in Rats With Traumatic Brain Injury Involving Polytrauma. THE JOURNAL OF PAIN 2023; 24:1383-1395. [PMID: 36958460 DOI: 10.1016/j.jpain.2023.03.009] [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: 09/29/2022] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
Traumatic brain injury (TBI) survivors often experience debilitating consequences. Due to the high impact nature of TBI, patients often experience concomitant peripheral injuries (ie, polytrauma). A common, yet often overlooked, comorbidity of TBI is chronic pain. Therefore, this study investigated how common concomitant peripheral injuries (ie, femoral fracture and muscle crush) can affect long-term behavioral and structural TBI outcomes with a particular focus on nociception. Rats were randomly assigned to 1 of 4 groups: polytrauma (POLY; ie, fracture + muscle crush + TBI), peripheral injury (PERI; ie, fracture + muscle crush + sham TBI), TBI (ie, sham fracture + sham muscle crush + TBI), and sham-injured (SHAM; ie, sham fracture + sham muscle crush + sham TBI). Rats underwent behavioral testing at 3-, 6-, and 11-weeks postinjury, and were then euthanized for postmortem magnetic resonance imaging (MRI). POLY rats had a persisting increase in pain sensitivity compared to all groups on the von Frey test. MRI revealed that POLY rats also had abnormalities in the cortical and subcortical brain structures involved in nociceptive processing. These findings have important implications and provide a foundation for future studies to determine the underlying mechanisms and potential treatment strategies for chronic pain in TBI survivors. PERSPECTIVE: Rats with TBI and concomitant peripheral trauma displayed chronic nociceptive pain and MRI images also revealed damaged brain structures/pathways that are involved in chronic pain development. This study highlights the importance of polytrauma and the affected brain regions for developing chronic pain.
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Affiliation(s)
- Ker Rui Wong
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - David K Wright
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Marissa Sgro
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Sabrina Salberg
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jesse Bain
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Crystal Li
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia; Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Rhys D Brady
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, Parkville, VIC, Australia; Department of Nursing, Health and Human Services, Vancouver Island University, Nanaimo, BC, Canada.
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17
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Chen PY, Su IC, Shih CY, Liu YC, Su YK, Wei L, Luh HT, Huang HC, Tsai PS, Fan YC, Chiu HY. Effects of Neurofeedback on Cognitive Function, Productive Activity, and Quality of Life in Patients With Traumatic Brain Injury: A Randomized Controlled Trial. Neurorehabil Neural Repair 2023:15459683231170539. [PMID: 37125901 DOI: 10.1177/15459683231170539] [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: 05/02/2023]
Abstract
BACKGROUND Cognitive impairment is common in patients with traumatic brain injury (TBI). Studies that have examined the effectiveness of neurofeedback (NFB) on cognitive function following TBI have had poor study designs and small sample sizes. OBJECTIVES This randomized controlled trial assessed the effects of low-resolution tomography Z-score NFB (LZNFB) and theta/beta NFB on cognitive impairment, return to productive activity, and quality of life in patients with TBI. METHODS We randomly assigned 87 patients with TBI with cognitive impairment to LZNFB, theta/beta NFB, or usual care (UC) groups. Patients in both NFB groups received weekly 60-minute treatment for 10 weeks, and those in the control group received UC and telephone interviews for 10 weeks. The primary outcome was cognitive function as measured by performance on cognitive tasks; the secondary outcomes included productive activity and quality of life based on the Community Integration Questionnaire-revised (CIQ-R) and the Quality of Life after Brain Injury (QOLIBRI), respectively, at baseline and immediately after the last intervention. RESULTS The LZNFB group exhibited significantly greater improvements in immediate recall, delayed recall, recognition memory, and selective attention compared with the UC group; the theta/beta NFB group exhibited improvements in only immediate memory and selective attention (P < .05). The total CIQ-R scores of the LZNFB group after treatment were significantly improved than those of the UC group were. CONCLUSION Consecutive LZNFB achieved therapeutic effects in memory, attention, and productive activity, whereas theta/beta NFB improved memory and attention in patients with TBI.This trial was prospectively registered at ClinicalTrial.gov (registration number: NCT03515317; https://clinicaltrials.gov/ct2/show/NCT03515317).
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Affiliation(s)
- Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital Keelung Branch, Keelung City, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung City, Taiwan
| | - I-Chang Su
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chun-Ying Shih
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Yen-Chun Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Yu-Kai Su
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li Wei
- Taipei Neuroscience Institute, Taipei Medical University, Taipei City, Taiwan
- Division of Neurosurgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan
| | - Hui-Tzung Luh
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Yen-Chun Fan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- Department of Nursing, Taipei Medical University Hospital, Taipei City, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
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18
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Lai WH, Hsu HH, Yu HT, Xiao SH, Tsai YH, Wang KC, Huang SJ, Lin CP, Yang CC. Long-term work quality of patients with mild traumatic brain injury: The associations with postconcussion symptoms. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 36881988 DOI: 10.1080/23279095.2023.2186232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Return to work (RTW) has always been a determinant functional outcome in patients with mild traumatic brain injury (MTBI). However, the quality of long-term RTW was still unclear. This study thus aims to examine long-term work quality and to reveal its associating factors. A total of 110 patients with MTBI was prospectively recruited. Post-concussion symptoms (PCS) and RTW were evaluated by the Checklist of Post-Concussion Symptoms (CPCS) and Work Quality Index (WQI) respectively at one-week and long-term evaluation (M = 2.90 years, SD = 1.29) post-injury. Only 16% of patients can successfully RTW at one-week post-injury, while 69% of patients have retained their jobs at long-term evaluations. Importantly, 12% of patients had to work under the adverse impacts of PCS at one-week after MTBI, and long-term WQI was significantly associated with PCS at one-week post-injury. Almost 1/3 of patients still had unfavorable long-term work quality even though they could return to work. Thus, a careful evaluation of the early PCS endorsement and work quality for patients with MTBI is merited.
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Affiliation(s)
- Wen-Hsuan Lai
- Connect with Passions Psychological Clinic, Taipei, Taiwan
| | - Huan-Hsuan Hsu
- Department of Neurology, Taichung Tzu Chi Hospital, Tanzih Township, Taiwan
| | - Hsiu-Ting Yu
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | | | - Yi-Hsin Tsai
- Department of Neurosurgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Chuan Wang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Jean Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
- Holistic Mental Health Center, Taipei City Hospital, Taipei, Taiwan
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19
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Blaauw J, Hertog HMD, Holl DC, Thüss NS, van der Gaag NA, Jellema K, Dammers R, Kho KH, Groen RJM, Lingsma HF, Jacobs B, van der Naalt J. The cognitive status of chronic subdural hematoma patients after treatment: an exploratory study. Acta Neurochir (Wien) 2023; 165:701-709. [PMID: 36752891 PMCID: PMC10006248 DOI: 10.1007/s00701-023-05508-7] [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: 06/28/2022] [Accepted: 12/29/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is a common neurological condition, often affecting the elderly. Cognitive impairment is frequently observed at presentation. However, the course and longer term aspects of the cognitive status of CSDH patients are unknown. In this study, we aim to explore the cognitive status of CSDH patients after treatment. METHODS An exploratory study in which CSDH patients were assessed 3 months after treatment and compared to healthy controls. A total of 56 CSDH patients (age 72.1 SD ± 10.8 years with 43 [77%] males) and 60 healthy controls were included (age 67.5 ± SD 4.8 with 34 [57%] males). Cognitive testing was performed using the Telephonic Interview of Cognitive Status-modified (TICS-m), a 12-item questionnaire in which a total of 50 points can be obtained on several cognitive domains. RESULTS Median time between treatment and cognitive testing was 93 days (range 76-139). TICS-m scores of CSDH patients were significantly lower than healthy controls, after adjusting for age and sex: mean score 34.6 (95% CI: 33.6-35.9) vs. 39.6 (95% CI: 38.5-40.7), p value < 0.001. More than half (54%) of CSDH patients have cognitive scores at follow-up that correspond with cognitive impairment. CONCLUSION A large number of CSDH patients show significantly worse cognitive status 3 months after treatment compared to healthy controls. This finding underlines the importance of increased awareness for impaired cognition after CSDH. Further research on this topic is warranted.
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Affiliation(s)
- Jurre Blaauw
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.
| | | | - Dana C Holl
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - Nikki S Thüss
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Neurology, Subdepartment of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Niels A van der Gaag
- Haaglanden Medical Center &, University Neurosurgical Center Holland (UNCH), Leiden University Medical Center, Haga Teaching Hospital, Leiden & The Hague, Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Centre, The Hague, Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - Kuan H Kho
- Department of Neurosurgery, Medisch Spectrum Twente, NeurocenterEnschede, Netherlands
- Clinical Neurophysiology Group, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, Groningen, Netherlands
| | - Hester F Lingsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bram Jacobs
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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20
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Guerrette MC, McKerral M. Predictors of Social Participation Outcome after Traumatic Brain Injury Differ According to Rehabilitation Pathways. J Neurotrauma 2023; 40:523-535. [PMID: 35974662 DOI: 10.1089/neu.2022.0232] [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: 11/13/2022] Open
Abstract
Social participation (SP) is one of many objectives in the rehabilitation of patients with traumatic brain injury (TBI). Studies on predictors of SP specific to post-acute universally accessible specialized rehabilitation pathways following TBI are scarce. Our objectives were to: 1) characterize SP, as well as a set of pre-injury, injury-related, and post-injury variables in individuals participating in inpatient-outpatient or outpatient rehabilitation pathways within a universally accessible and organized trauma continuum of care; and 2) examine the ability of pre-injury, injury-related, and post-injury variables in predicting SP outcome after TBI according to rehabilitation path. Participants (N = 372) were adults admitted to an inpatient-outpatient rehabilitation pathway or an outpatient rehabilitation pathway after sustaining a TBI between 2016 and 2020, and for whom Mayo-Portland Adaptability Intentory-4 (MPAI-4) outcomes were prospectively obtained at the start and end of rehabilitation. Additional data was collected from medical files. For both rehabilitation pathways, predicted SP outcome was MPAI-4 Participation score at discharge from outpatient rehabilitation. Multiple regression models investigated the predictive value of each variable for SP outcome, separately for each care pathway. Main findings show that for the inpatient-outpatient sample, three variables (education years, MPAI-4 Ability and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 49% of the variance. For the outpatient sample, five variables (pre-morbid hypertension and mental health diagnosis, total indirect rehabilitation hours received, MPAI-4 Abilities and Adjustment scores at rehabilitation intake) significantly predicted SP outcome, with the regression model accounting for 47% of the variance. In conclusion, different pre-morbid and post-injury variables are involved in predicting SP, depending on the rehabilitation path followed. The predictive value of those variables could help clinicians identify patients more likely of showing poorer SP at discharge and who may require additional or different interventions.
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Affiliation(s)
- Marie-Claude Guerrette
- Department of Psychology, Université de Montréal, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal-IURDPM, Montreal, Quebec, Canada
| | - Michelle McKerral
- Department of Psychology, Université de Montréal, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal-IURDPM, Montreal, Quebec, Canada
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21
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Guldager R, Nordentoft S, Poulsen I, Aadal L, Loft MI. Wants and needs for involvement experienced by relatives of patients with an acquired brain injury: a scoping review. JBI Evid Synth 2022; 21:886-912. [PMID: 36729839 DOI: 10.11124/jbies-22-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This scoping review identifies and maps the breadth of available evidence on relatives' wants and needs for involvement in the care of patients with an acquired brain injury. INTRODUCTION Acquired brain injuries often occur suddenly and unexpectedly. Suffering from an acquired brain injury has major consequences, not only for the patients, due to the devastating impact on their physical, cognitive, social, and psychological well-being, but also for the relatives who may need to take on a lifelong role as carers. Research has cited some benefits of involving relatives in the care of patients, including positive effects on the patients' health outcomes; however, there are few studies showing how relatives can be involved. INCLUSION CRITERIA Studies that defined or assessed relatives' wants and needs for involvement with the care of patients with an acquired brain injury in all settings were included. Studies were included if they described any kind of wants and needs for involvement experienced from the perspective of relatives. The review considered all study designs, except for literature reviews. METHODS The JBI methodology for conducting a scoping review was employed in accordance with an a priori published protocol. An extensive search was conducted in MEDLINE (PubMed), CINAHL (EBSCO), and Embase (Ovid). Gray literature was searched using Grey Matters and BASE. The initial search was conducted in February 2020 and updated in September 2021. This review was limited to studies published in English, German, or Scandinavian languages since January 2010. The data were extracted using a data extraction tool (authors, year of publication, country of origin, setting, study methods, and findings related to wants and needs for involvement) created by the authors. The review findings are reported as a descriptive summary, with tables and figures supporting the data. RESULTS The search identified 3854 studies, 31 of which were included. The studies were published between 2010 and 2021 and were conducted across 9 countries. In total, 16 studies applied a qualitative study design, 4 studies used a descriptive approach, 4 studies used a quantitative research design, 4 studies reported using a mixed methods design, and 3 studies employed a multi-methods design. The studies were conducted across a variety of settings, ranging from acute care to home. The international literature on the involvement of relatives with patients with acquired brain injuries comprises multiple published studies on different aspects of the topic and within various care contexts. The findings identified few studies describing wants and needs experienced by relatives in relation to involvement in the patient's disease trajectory. CONCLUSIONS The findings show that relatives' wants and needs are primarily related to information and communication, but are also related to collaboration with health care professionals. The findings illustrate that the complexity of involvement is comprehensive, with multiple aspects to consider.
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Affiliation(s)
- Rikke Guldager
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Sara Nordentoft
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital Hvidovre, Denmark.,Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
| | - Lena Aadal
- Hammel Neurorehabilitation and Research Centre, Hammel, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mia Ingerslev Loft
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark.,Department of Neurology, Rigshospitalet, Copenhagen, Denmark
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22
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Libeson L, Ross P, Downing M, Ponsford J. Exploring employment following traumatic brain injury in persons who completed an insurer funded vocational rehabilitation program in Australia. Disabil Rehabil 2022; 44:7428-7438. [PMID: 34689670 DOI: 10.1080/09638288.2021.1992516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To extend the authors' previous research by investigating the maintenance of work performance over time and the long-term experience of employment following traumatic brain injury (TBI). MATERIALS AND METHODS Semi-structured interviews were conducted with a sample of 72 individuals with predominantly severe TBI, up to 10-years post-injury. Thematic analysis of transcribed interviews was conducted. RESULTS Four key themes were identified: brain injury influences on work performance and long-term employment; factors optimising long-term employment; and need for compromise and acceptance, which all impacted the final theme, quality of life outcome. While TBI-related difficulties such as fatigue, cognitive, and emotional difficulties still impacted work many years post-injury, work modifications and employer and vocational rehabilitation (VR) support were important factors optimising long-term employment. The timing of return to work (RTW) was also an important and potentially modifiable factor influencing work performance, which appeared to have long-term effects on the maintenance of employment. Support for acceptance of altered career goals is needed. CONCLUSION Findings support the need for early VR to facilitate employer contact, to maximise adjustment and preparation time before RTW, to educate both employees and employers and to implement work modifications to support continuing employment after TBI.Implications for rehabilitationThe maintenance of employment following TBI is of critical importance for financial independence, psychological and social well-being, and improved quality of life.Injury-related difficulties still impact work performance many years after injury requiring individuals with TBI to continue working in modified roles and for reduced hours over the long-term.Ongoing VR and employer support is needed to facilitate long-term work modifications and compensatory strategies to support work performance.Early VR involvement to facilitate employer contact and maximise adjustment and preparation time before returning to work is necessary to avoid the negative and potentially dire consequences of returning too early.Psychological support to facilitate acceptance of role changes and career compromises is also important.
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Affiliation(s)
- Lauren Libeson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Pamela Ross
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia.,Epworth HealthCare, Richmond, Australia
| | - Marina Downing
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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23
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Libeson L, Ross P, Downing M, Ponsford J. The experience of employers of individuals with traumatic brain injury. Neuropsychol Rehabil 2022; 32:2580-2602. [PMID: 34461816 DOI: 10.1080/09602011.2021.1969252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To understand the experience of employers of individuals with traumatic brain injury (TBI) who have received comprehensive vocational rehabilitation (VR), the factors involved in supporting an individual with TBI to return to work (RTW), and the support needs of employers. METHODS 12 employers completed semi-structured interviews, which were recorded, transcribed, and analysed thematically. RESULTS Five main themes were identified: challenges and impact on employer, managing employee post-injury changes, looking after employee wellbeing, managing conflicting emotions, and utilizing sources of support. Although employers received support with operational challenges, findings suggest they were not prepared for the emotional journey. While they struggled to support employees through the difficult process of realizing they could no longer perform at their pre-injury level, employers strove to find appropriate roles and ensure wellbeing for their injured employees. Despite employers' endeavours, they felt this process was demoralizing for some employees. CONCLUSIONS Advising employers on operational as well as emotional support needs of both employees and employers is an ongoing challenge for VR providers. Although unsupportive employers were not well-represented in this sample, the study highlights the challenges faced and strategies used by employers who have a strong personal investment in the successful RTW of their employees.
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Affiliation(s)
- Lauren Libeson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Pamela Ross
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia.,Epworth HealthCare, Richmond, Australia
| | - Marina Downing
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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24
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Downing MG, Hicks AJ, Braaf S, Myles DB, Gabbe BJ, Ponsford J. "It's been a long hard road": challenges faced in the first three years following traumatic brain injury. Disabil Rehabil 2022; 44:7439-7448. [PMID: 34890511 DOI: 10.1080/09638288.2021.1992517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE There is limited qualitative research exploring challenges experienced following severe traumatic brain injury (TBI). We investigated challenges to recovery identified by individuals who sustained severe TBI three years earlier or their close others (COs), as well as suggestions for managing these challenges. MATERIALS AND METHODS Nine participants with TBI and 16 COs completed semi-structured interviews. Using reflexive thematic analysis, challenges were identified across several timeframes (i.e., at the injury, acute care, inpatient rehabilitation, outpatient rehabilitation, and at home/other location). RESULTS Challenges experienced across all timeframes included: lack of information and poor communication, pre-existing conditions, missed injuries, and issues with medical staff, and continuity of care. From acute care onwards, there were TBI-related consequences, issues with coping and emotional adjustment, negative outlook, insufficient treatment, lack of support for COs, and issues with compensation and funding for rehabilitation needs. Some challenges were unique to a specific timeframe (e.g., over-stimulating ward setting during acute care, and limited or unsupportive families once injured individuals went home). Suggestions for managing some of the challenges were provided (e.g., information provision, having peer supports). CONCLUSION Suggestions should be considered to promote successful outcomes following severe TBI.IMPLICATIONS FOR REHABILITATIONRecovery following a severe traumatic brain injury can be hindered by challenges, such as poor communication, limited information provision, injury-related consequences, limited services and emotional support for the injured individual and their Close Others, and a need for education of the broader community about traumatic brain injury.Suggestions for managing these challenges (e.g., peer supports; services closer to home) could be used to inform clinical guidelines that could be used in a rehabilitation context.These suggestions ultimately aim to improve the post-injury experience and outcomes of individuals with traumatic brain injury and their Close Others.
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Affiliation(s)
- Marina G Downing
- Monash Epworth Rehabilitation Research Centre (MERRC), School of Psychological Sciences, Monash University, Melbourne, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Amelia J Hicks
- Monash Epworth Rehabilitation Research Centre (MERRC), School of Psychological Sciences, Monash University, Melbourne, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Sandy Braaf
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniel B Myles
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre (MERRC), School of Psychological Sciences, Monash University, Melbourne, Australia.,School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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25
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Bystrup MR, Hindhede AL, Pallesen H, Aadal L, Larsen K. Unequal neurorehabilitation trajectories - a longitudinal case study combining field structures with social Class-Based Capital Conversion. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:293-308. [PMID: 35220921 DOI: 10.1080/14461242.2021.2007161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/08/2021] [Indexed: 06/14/2023]
Abstract
Inequalities in illness, service provision, and outcomes are well documented in the Nordic universal welfare state. The ways in which inequalities are produced during illness recovery trajectories remain largely unknown. Long-term brain injury rehabilitation in this context provides a window into veiled aspects of inequality and the underlying mechanisms. We examine inequality empirically by combing framing field structures with the classed abilities of families to mobilise capital after a severe acquired brain injury (severe ABI). Using a Bourdieuan theoretical framework, informed by the concepts of field, doxa, cultural health capital (CHC), and rehabilitation capital (RC), we designed a longitudinal case study encompassing professional records, observations, and interviews that tracked and analysed subjects' trajectories. We found that families' consistent accumulation and conversion of capital was crucial after a severe ABI because of the multifaceted rehabilitation process involving many different field specific agendas and doxas. This study supplements previous concepts (CHC and RC) developed in a health care context by including other rehabilitation contexts. These disparities in forms of capital amongst social classes result in winners and losers and were reflected in the rehabilitation trajectories of the young adults, characterised by continuity on one extreme and broken trajectories on the other.
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Affiliation(s)
- Mette Ryssel Bystrup
- Department of Culture and Learning, Aalborg University, Copenhagen, Denmark
- Department of Clinical Medicine, Hammel Neurorehabilitation and Research Center, Aarhus University, Hammel, Denmark
| | | | - Hanne Pallesen
- Department of Clinical Medicine, Hammel Neurorehabilitation and Research Center, Aarhus University, Hammel, Denmark
| | - Lena Aadal
- Department of Clinical Medicine, Hammel Neurorehabilitation and Research Center, Aarhus University, Hammel, Denmark
| | - Kristian Larsen
- The University Hospital Centre for Health Research, Copenhagen, Denmark
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26
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Ramanathan P, Liu R, Chen MH, Kennedy MRT. Memory and Executive Functions Subserving Judgments of Learning: Cognitive Reorganization After Traumatic Brain Injury. Neuropsychol Rehabil 2022; 32:2203-2226. [PMID: 34006181 DOI: 10.1080/09602011.2021.1929345] [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: 12/27/2022]
Abstract
We investigated relationships between psychometric measures of memory, executive functions (EFs), and task-based measures of Judgments of Learning (JOLs) in individuals with and without Traumatic Brain Injury (TBI), to study functional reorganization after TBI. We hypothesized that, in controls, accuracy of immediate JOLs would be associated with short-term memory and EFs (but not long-term memory, LTM), while accuracy of delayed JOLs would be associated primarily with LTM. We hypothesized that those with good recovery from TBI would demonstrate functional reorganization of the relationships between memory, EFs, and JOLs. Eighteen individuals with TBI and 18 matched controls completed eight neuropsychological tests of memory and EFs. They studied word-pairs, made immediate and delayed JOLs, and took a cued-recall test for the studied word-pairs. Stepwise regression and Lasso analyses generated a predictive model of JOL accuracy for each group. Accuracy of immediate JOLs in controls was predicted by short-term memory, inhibition, switching, and cognitive fluency, while accuracy of delayed JOLs was predicted by verbal recall. In individuals with TBI, inhibition predicted immediate JOL accuracy and switching predicted delayed JOL accuracy. Cognitive reorganization in those with good long-term recovery from TBI may account for the ability to make JOLs with accuracy similar to controls.
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Affiliation(s)
- Pradeep Ramanathan
- Department of Speech, Language, and Hearing Sciences, California State University, Hayward, CA, USA
| | - Ran Liu
- Statistics, Takeda Pharmaceutical Co. Limited, Cambridge, MA, USA
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Mary R T Kennedy
- Department of Communication Sciences and Disorders, Chapman University, Irvine, CA, USA
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27
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Tian M, Mao L, Zhang L. Crosstalk among N6-methyladenosine modification and RNAs in central nervous system injuries. Front Cell Neurosci 2022; 16:1013450. [PMID: 36246528 PMCID: PMC9556889 DOI: 10.3389/fncel.2022.1013450] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Central nervous system (CNS) injuries, including traumatic brain injury (TBI), intracerebral hemorrhage (ICH) and ischemic stroke, are the most common cause of death and disability around the world. As the most common modification on ribonucleic acids (RNAs), N6-methyladenosine (m6A) modification has recently attracted great attentions due to its functions in determining the fate of RNAs through changes in splicing, translation, degradation and stability. A large number of studies have suggested that m6A modification played an important role in brain development and involved in many neurological disorders, particularly in CNS injuries. It has been proposed that m6A modification could improve neurological impairment, inhibit apoptosis, suppress inflammation, reduce pyroptosis and attenuate ferroptosis in CNS injuries via different molecules including phosphatase and tensin homolog (PTEN), NLR family pyrin domain containing 3 (NLRP3), B-cell lymphoma 2 (Bcl-2), glutathione peroxidase 4 (GPX4), and long non-coding RNA (lncRNA). Therefore, m6A modification showed great promise as potential targets in CNS injuries. In this article, we present a review highlighting the role of m6A modification in CNS injuries. Hence, on the basis of these properties and effects, m6A modification may be developed as therapeutic agents for CNS injury patients.
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Affiliation(s)
- Mi Tian
- Department of Anesthesiology, Affiliated Zhongda Hospital of Southeast University, Nanjing, Jiangsu, China
| | - Lei Mao
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Li Zhang
- Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
- *Correspondence: Li Zhang,
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28
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Yabuno S, Yasuhara T, Murai S, Yumoto T, Naito H, Nakao A, Date I. Predictive Factors of Return Home and Return to Work for Intensive Care Unit Survivors after Traumatic Brain Injury with a Follow-up Period of 2 Years. Neurol Med Chir (Tokyo) 2022; 62:465-474. [PMID: 36130904 PMCID: PMC9637400 DOI: 10.2176/jns-nmc.2022-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intensive care unit (ICU) survivors after traumatic brain injury (TBI) frequently have serious disabilities with subsequent difficulty in reintegration into society. We aimed to investigate outcomes for ICU survivors after moderate to severe TBI (msTBI) and to identify predictive factors of return home (RH) and return to work (RTW). This single-center retrospective cohort study was conducted on all trauma patients admitted to the emergency ICU of our hospital between 2013 and 2017. Of these patients, adult (age ≥ 18 years) msTBI patients with head Abbreviated Injury Scale ≥ 3 were extracted. We performed univariate/multivariate logistic regression analyses to explore the predictive factors of RH and RTW. Among a total of 146 ICU survivors after msTBI, 107 were included (median follow-up period: 26 months). The RH and RTW rates were 78% and 35%, respectively. Multivariate analyses revealed that the predictive factors of RH were age < 65 years (P < 0.001), HR < 76 bpm (P = 0.015), platelet count ≥ 19 × 104/μL (P = 0.0037), D-dimer < 26 μg/mL (P = 0.034), and Glasgow Coma Scale (GCS) score > 8 (P = 0.0015). Similarly, the predictive factors of RTW were age < 65 years (P < 0.001) and GCS score > 8 (P = 0.0039). This study revealed that “age” and “GCS score on admission” affected RH and RTW for ICU survivors after msTBI.
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Affiliation(s)
- Satoru Yabuno
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Satoshi Murai
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Isao Date
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
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29
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Nielsen IH, Poulsen I, Larsen K, Larsen NS. Life goals as a driving force in traumatic brain injury rehabilitation: a longitudinal dyadic perspective. Brain Inj 2022; 36:1158-1166. [PMID: 36047479 DOI: 10.1080/02699052.2022.2109748] [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: 11/02/2022]
Abstract
BACKGROUND Traumatic brain injury significantly impacts survivors and their families. Rehabilitation following traumatic brain injury is often complex due to the physical, psychological, and socio-economic problems survivors face. Life goals are considered a motivational factor in rehabilitation. OBJECTIVE The aim was to explore expectations, problems, and strategies for goal setting in survivors of traumatic brain injury and their family caregivers for one-year during rehabilitation. METHODS A longitudinal qualitative study using dyadic interviews with survivors and family caregivers was carried out at three time points during the first year following traumatic brain injury. Data was analyzed according to Braun and Clarke's thematic analysis. RESULTS Eight survivors of traumatic brain injury and their family caregivers completed 24 interviews. Three themes and one sub-theme were identified: 1) life goals as a driving force (subtheme: dyadic discrepancies and conflicts); 2) conflicts between specific, measurable, achievable, realistic, and timed (SMART) goals and life goals; and 3) changing perceptions of the impact of impairments. CONCLUSIONS Life goals are important motivation in the rehabilitation process. Health care professionals must integrate life goals and rehabilitation goals (i.e. SMART goals) to decrease barriers and survivor ambivalence about rehabilitation. Involving both survivors and family caregivers in goal setting increases rehabilitation success.
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Affiliation(s)
- Iben Husted Nielsen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Hvidovre, Denmark.,Department of Nursing and Health Care, Aarhus University, Aarhus C, Denmark
| | - Kristian Larsen
- Department of Public Health, University of Copenhagen, Copenhagen N, Denmark.,Copenhagen University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital - Rigshospitalet, Copenhagen N, Denmark.,Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Niels Sandholm Larsen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
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30
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Pertz M, Braunwarth JI, Steinbach J, Wißing S, Thoma P. Social problem solving and trait socioemotional abilities in ambulatory stroke patients. J Clin Exp Neuropsychol 2022; 44:195-209. [PMID: 35856742 DOI: 10.1080/13803395.2022.2101619] [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: 10/17/2022]
Abstract
INTRODUCTION Stroke has been associated with sociocognitive impairment, so far well documented for emotion recognition and Theory of Mind. However, more complex abilities, such as social problem solving, which directly facilitate appropriate behavior in social situations have been neglected in previous research. METHOD The present study aimed to address this gap by focusing on performance-based social problem solving abilities and self-reported socioemotional abilities (i.e., empathy and alexithymia) in outpatient stroke patients (n = 36) compared to a group of healthy controls (n = 36) equivalent on age, gender, and education. In further analyses, potential lateralization effects and correlations between social problem solving/socioemotional functioning and demographic and clinical data were investigated. RESULTS In the main analyses, patients were impaired in their ability to freely generate appropriate solutions for challenging interpersonal situations depicted in written scenarios but performed on a comparable level as healthy controls when they had to choose the optimal solution presented amidst a range of less optimal options. While showing difficulty in identifying the awkward elements in the scenarios, the patient group nevertheless rated the degree of discomfort attributed to these elements on a level comparable to the control group. On the self-report measures, stroke patients reported overall higher degrees of alexithymia (i.e., an inability to describe and identify one's own and other persons´ emotions) and more personal distress in response to other individuals´ emotional suffering as assessed by self-report. CONCLUSIONS The present results suggest that stroke is associated with a broad impact on socioemotional and social problem solving abilities. As difficulties in social problem solving might be associated with increased psychosocial burden they ought to be addressed in stroke rehabilitation.
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Affiliation(s)
- Milena Pertz
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Jana Isabelle Braunwarth
- Faculty of Psychology, Neuropsychological Therapy Centre (NTC), Ruhr University Bochum, Bochum, Germany
| | - Jasmin Steinbach
- Faculty of Psychology, Neuropsychological Therapy Centre (NTC), Ruhr University Bochum, Bochum, Germany
| | | | - Patrizia Thoma
- Faculty of Psychology, Neuropsychological Therapy Centre (NTC), Ruhr University Bochum, Bochum, Germany
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31
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Steensgaard R, Hundborg MO, Pallesen H, Aadal L. What is a meaningful life for persons with acquired neurological impairments? A scoping review protocol. PLoS One 2022; 17:e0269125. [PMID: 35709200 PMCID: PMC9202831 DOI: 10.1371/journal.pone.0269125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/13/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE This scoping review explores the constitution of a meaningful life as perceived by adults with acquired neurological impairment following an injury or a disease. INTRODUCTION A neurological injury or disease imposes extensive life changes on the affected person and his or her close relatives. Including the patients' perception of a meaningful life is crucial to facilitate adjustment of any rehabilitation initiatives to the patients' wishes, hopes, needs, and preferences. Even so, the descriptions and common traits of a meaningful life from the impaired person's perspective are scarcely covered in the literature. Hence, a scoping review of existing knowledge is needed to facilitate quality rehabilitation and research initiatives. INCLUSION CRITERIA All studies, regardless of their design, are included provided they describe a meaningful life as considered or experienced by persons aged 18 years or more with neurological impairment. METHODS A PICo framework defines the search algorithms used in the databases MEDLINE, Cinahl, PsycINFO and Embase. Using Covidence, the scoping review systematically organizes the identified articles to provide a broad description of the study phenomenon. Furthermore, titles, abstracts, and full-text articles are screened independently by two reviewers to determine if they meet the inclusion criteria. In case of disagreement, a third and fourth reviewer are consulted. The scoping will be reported according to the PRISMA- SCR checklist.
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Affiliation(s)
- Randi Steensgaard
- Knowledge Centre for Neurorehabilitation of Western Denmark, Roskilde, Denmark
- Spinal Cord Injury Centre of Western Denmark, Neurology, Central Regional Hospital, Viborg, Denmark
| | - Michele Offenbach Hundborg
- Knowledge Centre for Neurorehabilitation of Western Denmark, Roskilde, Denmark
- Specialised Center for Brain Injury, Central Denmark Region, Viborg, Denmark
| | - Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lena Aadal
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, University of Aarhus, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Boyko M, Gruenbaum BF, Shelef I, Zvenigorodsky V, Severynovska O, Binyamin Y, Knyazer B, Frenkel A, Frank D, Zlotnik A. Traumatic brain injury-induced submissive behavior in rats: link to depression and anxiety. Transl Psychiatry 2022; 12:239. [PMID: 35672289 PMCID: PMC9174479 DOI: 10.1038/s41398-022-01991-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Traumatic brain injury (TBI) affects millions of people worldwide, many of whom are affected with post-TBI mood disorders or behavioral changes, including aggression or social withdrawal. Diminished functionality can persist for decades after TBI and delay rehabilitation and resumption of employment. It has been established that there is a relationship between these mental disorders and brain injury. However, the etiology and causal relationships behind these conditions are poorly understood. Rodent models provide a helpful tool for researching mood disorders and social impairment due to their natural tendencies to form social hierarchies. Here, we present a rat model of mental complications after TBI using a suite of behavioral tests to examine the causal relationships between changes in social behavior, including aggressive, hierarchical, depressive, and anxious behavior. For this purpose, we used multivariate analysis to identify causal relationships between the above post-TBI psychiatric sequelae. We performed statistical analysis using principal component analysis, discriminant analysis, and correlation analysis, and built a model to predict dominant-submissive behavior based on the behavioral tests. This model displayed a predictive accuracy of 93.3% for determining dominant-submissive behavior in experimental groups. Machine learning algorithms determined that in rats, aggression is not a principal prognostic factor for dominant-submissive behavior. Alternatively, dominant-submissive behavior is determined solely by the rats' depressive-anxious state and exploratory activity. We expect the causal approach used in this study will guide future studies into mood conditions and behavioral changes following TBI.
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Affiliation(s)
- Matthew Boyko
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
| | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ilan Shelef
- Department of Radiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Vladislav Zvenigorodsky
- Department of Radiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Olena Severynovska
- Department of Biochemistry and Physiology of the Faculty of Biology and Ecology Oles Gonchar of the Dnipro National University, Dnipro, Ukraine
| | - Yair Binyamin
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Boris Knyazer
- Department of Ophthalmology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Amit Frenkel
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Dmitry Frank
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology and Critical Care, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
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Corti C, Oprandi MC, Chevignard M, Jansari A, Oldrati V, Ferrari E, Martignoni M, Romaniello R, Strazzer S, Bardoni A. Virtual-Reality Performance-Based Assessment of Cognitive Functions in Adult Patients With Acquired Brain Injury: A Scoping Review. Neuropsychol Rev 2022; 32:352-399. [PMID: 33929656 DOI: 10.1007/s11065-021-09498-0] [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: 06/10/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
Individuals with acquired brain injury (ABI) commonly present with impairments in cognitive abilities. As these competencies seem to be predictive of patients' abilities to reintegrate into the everyday settings, it is crucial to assess them properly. However, previous research has indicated that patients may perform relatively well on standard tests of cognitive functioning, but may nonetheless encounter significant difficulties in organizing and executing everyday tasks. In order to overcome this issue, virtual reality (VR) methods have been introduced in clinical practice with the aim of creating assessments that simulate real-world activities and thus, provide a clearer picture of patients' functioning in everyday settings. This review offers an overview of VR assessment tools described in the scientific literature between 2010 and 2019. Overall, 38 relevant records describing 31 different tools were found. Among these tools, 16 assessed executive functions and prospective memory, while the other 15 assessed visuo-spatial abilities. Although promising results have been reported, our analysis indicated that about half of the tools deliver tasks that differ from everyday activities, thus limiting the generalizability of patients' performance to the real-world. Moreover, a variety of methodological shortfalls related to study Internal and External Validity have been highlighted, which hamper the possibility of drawing definite recommendations on tool choice. These limitations suggest the importance of putting considerable efforts into the improvement or development of VR tools for patients with ABI for both research and clinical purposes, considering the great potential of this form of assessment.
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Affiliation(s)
- Claudia Corti
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy.
| | | | - Mathilde Chevignard
- Rehabilitation Department for Children with Acquired Brain Injury, Saint Maurice Hospital, Saint Maurice, France
- Laboratoire D'Imagerie Biomedicale (LIB), Sorbonne Université, Paris, France
- GRC 24 Handicap Moteur Et Cognitif Et Réadaptation (HaMCRe), Sorbonne Université, Paris, France
| | | | - Viola Oldrati
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | | | | | - Sandra Strazzer
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
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Bystrup MR, Aadal L, Pallesen H, Larsen K, Hindhede AL. Who are relatives? Young adults, relatives and professionals' perceptions of relatives during the rehabilitation of young adults with a severe acquired brain injury. Disabil Rehabil 2022; 45:1655-1666. [PMID: 35559686 DOI: 10.1080/09638288.2022.2072959] [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: 11/03/2022]
Abstract
PURPOSE This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). METHODS This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. RESULTS Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. CONCLUSION The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Implications for rehabilitationRehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement.The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations.Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process.Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run.
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Affiliation(s)
- Mette Ryssel Bystrup
- Department of Culture and Learning, Aalborg University, Copenhagen SV, Denmark.,Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Lena Aadal
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Hanne Pallesen
- Department of Clinical Medicine, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Kristian Larsen
- The University Hospital Centre for Health Research (UCSF) & University of Copenhagen, Copenhagen, Denmark
| | - Anette L Hindhede
- The University Hospital Centre for Health Research (UCSF) & University of Copenhagen, Copenhagen, Denmark
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Witten JA, Coetzer R, Turnbull OH. Shades of Rage: Applying the Process Model of Emotion Regulation to Managing Anger After Brain Injury. Front Psychol 2022; 13:834314. [PMID: 35369166 PMCID: PMC8971361 DOI: 10.3389/fpsyg.2022.834314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Uncontrollable anger is common following an acquired brain injury (ABI), with impaired emotion regulation (ER) being one of the main contributors. Existing psychological interventions appear moderately effective, though studies typically include limitations such as small sample sizes, issues of long-term efficacy, and standardization of content. While ER has been a popular research field, the study of ER for anger management after ABI is less well investigated, and contains few interventions based on the widely used Process Model of ER. This review surveys the efficacy of ER strategies in individuals with ABI, and proposes a novel research design for future interventions. Recommendations are made about: strategy number and type, shared decision-making, approaches to data analysis, and mode of delivery.
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Affiliation(s)
- Jade Abigail Witten
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
| | - Rudi Coetzer
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
- The Disabilities Trust, Wakefield, United Kingdom
| | - Oliver H. Turnbull
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
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Green-McKenzie J, Shofer FS, Matthei J, Biester R, Deibler M. Clinical and Psychological Factors Associated With Return to Work Among United States Diplomats Who Sustained a Work-Related Injury While on Assignment in Havana, Cuba. J Occup Environ Med 2022; 64:212-217. [PMID: 34873135 PMCID: PMC8887843 DOI: 10.1097/jom.0000000000002450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine factors associated with return to work in US diplomats injured during a work assignment in Cuba. METHODS In this case series work ability was determined at each visit. Questionnaires used included the Symptom Score Questionnaire, Beck Anxiety Inventory, Beck Depression Inventory, Quality-of-Life Inventory, and Patient Health Questionnaire. RESULTS Of the 45 employees referred to Occupational Medicine, the mean age was 42.5 years, 60% were men, 68% were never out of work, 22% were out of work for some period, and 15% remain out of work. Vestibular, cognitive, hearing, sleep, and visual symptoms, and a higher initial symptom score were significantly associated with work inability while psychiatric symptoms were not. CONCLUSIONS This exposure resulted in prolonged illness with cognitive impairment and other clinical manifestations associated with work inability.
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Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine; Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Dr Green-McKenzie); Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine (Dr Shofer); SHARP Rees-Stealy Medical Group, San Diego, California (Dr Matthei);University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Dr Matthei); Department of Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Dr Biester); Rehabilitation Medicine Service, Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania (Dr Biester); The Center or Emotional Health of Greater Philadelphia, Philadelphia, Pennsylvania (Dr Deibler)
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Chen F, Chi J, Niu F, Gao Q, Mei F, Zhao L, Hu K, Zhao B, Ma B. Prevalence of suicidal ideation and suicide attempt among patients with traumatic brain injury: A meta-analysis. J Affect Disord 2022; 300:349-357. [PMID: 34995702 DOI: 10.1016/j.jad.2022.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/03/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Suicidality is common among patients with traumatic brain injury (TBI). This meta-analysis aimed to assess the prevalence of suicidal ideation (SI) and suicide attempt (SA) in TBI patients. METHODS Databases including PubMed, Cochrane Library, Embase, CINAHL, Web of Science, PsycINFO, China National Knowledge Infrastructure (CNKI), VIP, WanFang Data, and Chinese Biomedical Literature Database (CBM) were searched for relevant literature from inception to 9th January 2021. Random effects models were used to estimate the prevalence of SI and SA. The methodological quality of the included studies was assessed using the modified Newcastle-Ottawa Scale. Subgroup analysis was performed based on the geographical location of the institutions. RESULTS A total of 16 studies involving 1,146,271 patients with TBI were included in our meta-analysis. The prevalence of SI and SA were 19.1% (95% CI 13.6-24.6%) and 2.1% (95% CI 1.8-2.4%), respectively, while the prevalence of SA in Asian and non-Asian countries were 2.0% (95% CI 0.3-3.7%) and 2.0% (95% CI 1.6-2.3%). Meta-regression analyses revealed that the publication year and age were positively associated, while the geographical location of the institution and sample size were negatively associated with the pooled prevalence of SI. On the other hand, the geographical location of the institution, sample size and age were negatively associated with the pooled prevalence of SA. LIMITATIONS The overall heterogeneity between studies was high. CONCLUSION SI and SA are common among TBI patients. Therefore, targeted preventive measures are paramount to manage TBI-related suicide.
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Affiliation(s)
- Fei Chen
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, Gansu 730000, China
| | - Junting Chi
- The First People's Hospital of Yunnan Province, Kunming, China
| | - Fang Niu
- Department of Intensive Care Unit, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Qianqian Gao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Fan Mei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Li Zhao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Kaiyan Hu
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Bing Zhao
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, Gansu 730000, China
| | - Bin Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, No.199, Donggang West Road, Chengguan District, Lanzhou, Gansu 730000, China.
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38
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Linnestad AM, Løvstad M, Groven KS, Howe EI, Fure SCR, Spjelkavik Ø, Sveen U. "Manoeuvring in uncharted waters - a balancing act": A qualitative exploration of treatment and improvement after mild traumatic brain injury. Neuropsychol Rehabil 2022; 33:592-612. [PMID: 35168477 DOI: 10.1080/09602011.2022.2034651] [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: 10/19/2022]
Abstract
Background: Individuals who have sustained mild traumatic brain injury (mTBI) with a protracted course of recovery may experience long-lasting somatic, cognitive, and emotional symptoms affecting activities of daily living. There is limited knowledge regarding individuals' lived experiences with treatments and advice provided.Purpose: To explore how individuals with mTBI describe and make sense of their injury, recovery process, and their experiences with various treatment approaches.Methods: Eight participants with mTBI were recruited from the intervention group in an ongoing randomized controlled trial regarding return-to-work. They were interviewed once after treatment delivery using a qualitative hermeneutical approach. Thematic analysis was applied, and findings are discussed in light of a salutogenic theory.Results: Participants expressed uncertainty regarding conflicting advice they received in the early phase of recovery. Three main themes were developed: (1) "Ambiguity and hope"; (2) "Uncertainty concerning activity and rest"; and (3) "To become the person I used to be vs. to become a new version of myself."Conclusion: The findings showed that the participants experienced both uncertainty and hope for further recovery. The recovery process is challenged by the variability of TBI symptoms that affects participation in everyday life, as well as the conflicting advice received by the participants.
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Affiliation(s)
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Karen Synne Groven
- Faculty of Health, VID Specialized University, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Silje Christine Reistad Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Unni Sveen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
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Jammula VR, Leeper H, Gilbert MR, Cooper D, Armstrong TS. Effects of Cognitive Reserve on Cognition in Individuals With Central Nervous System Disease. Cogn Behav Neurol 2021; 34:245-258. [PMID: 34508028 PMCID: PMC8635253 DOI: 10.1097/wnn.0000000000000282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/13/2021] [Indexed: 11/27/2022]
Abstract
Cognitive reserve (CR) has been proposed to account for functional outcome differences in brain pathology and its clinical manifestations. The purpose of our paper is to systematically review the effects of CR on cognitive outcomes in individuals with neurodegenerative and structural CNS diseases. We performed a systematic search of PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsychInfo using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Seventeen studies met the predetermined inclusion criteria and were selected for review. Education level was the most commonly used measure for CR, and various neuropsychological tests were used to measure cognitive outcomes. Regardless of the CNS disease of the individuals, almost all of the studies reported a positive association between CR and cognitive outcomes when they were evaluated cross-sectionally. However, when evaluated longitudinally, CR had either no effect on, or a negative association with, cognitive outcomes. Based on studies across a broad spectrum of CNS diseases, our findings suggest that CR may serve as a predictor of cognitive outcomes in individuals with CNS diseases. However, studies to date are limited by a lack of imaging analyses and standardized assessment strategies. The ability to use a standardized measure to assess the longitudinal effects of CR may allow for the development of more targeted treatment methods, resulting in improved disease outcomes for individuals.
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Affiliation(s)
- Varna R. Jammula
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Heather Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark R. Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Diane Cooper
- NIH Library/Office of Research Services, National Institutes of Health, Bethesda, Maryland
| | - Terri S. Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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40
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Guldager R, Poulsen I, Aadal L, Nordentoft S, Loft MI. Family involvement in the treatment of patients with an acquired brain injury or malignant brain tumor: a scoping review protocol. JBI Evid Synth 2021; 19:3190-3197. [PMID: 34132239 DOI: 10.11124/jbies-20-00398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review is to scope the evidence on the wants and needs of families with regards to their level of involvement in treatment for patients with an acquired brain injury or malignant brain tumor. INTRODUCTION Severe acquired brain injury and malignant brain tumor are diseases occurring unexpectedly and suddenly. Sustaining a severe acquired brain injury or malignant brain tumor has major consequences for patients and their relatives because of its devastating impact on physical, cognitive, social, and psychological well-being. The neurocognitive deficits have been shown to put strain on families in particular. INCLUSION CRITERIA This scoping review will consider studies involving relatives (≥18 years) of patients (≥18 years) with severe acquired brain injury or malignant brain tumor (WHO grade 3 and 4) from different settings (municipalities, primary care, health care centers, hospital, and long-term care institutions). Studies will be included if they describe any kind of involvement by relatives, and the review will consider all study designs, regardless of their rigor. METHODS Indexed and gray literature in English, Scandinavian, or German from January 2010 to the present will be considered. The searches will be conducted using bibliographic databases. Studies will be independently screened according to the inclusion criteria by two reviewers based on title, abstract, and full text. In case of disagreement, a third and fourth reviewer will be consulted. A customized data extraction form will be used to extract data from the included studies. The results will be presented in tabular form, accompanied by a narrative summary related to the objective of the present scoping review.
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Affiliation(s)
- Rikke Guldager
- Neurosurgical department, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Neurorehabilitation, TBI Unit, Rigshospitalet, Hvidovre, Denmark
| | - Lena Aadal
- Hospitalsenhed Midt, Hammel Neurorehabilitation and Research Centre, Hammel, Denmark
| | - Sara Nordentoft
- Neurosurgical department, Rigshospitalet, Copenhagen, Denmark
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Karcz K, Trezzini B, Escorpizo R, Schwegler U, Finger M. Factors associated with sustaining work after an acquired brain injury: a scoping review. Disabil Rehabil 2021; 44:6510-6530. [PMID: 34590966 DOI: 10.1080/09638288.2021.1960439] [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: 10/20/2022]
Abstract
PURPOSE Maintaining work in the long term represents a major challenge for people with acquired brain injury (ABI) as evidenced by a high rate of premature labour market dropouts. The present study aimed to compile factors associated with working in the long term after sustaining an ABI. MATERIALS AND METHODS We carried out a scoping review synthesizing quantitative and qualitative research conducted between 2000 and 2021. Databases searched comprised PubMed, CINAHL Complete, PsycINFO, Scopus, and Web of Science. RESULTS Ten quantitative and nine qualitative studies were included, all but one from high-resource countries. Quantitative research predominantly comprised longitudinal follow-ups on individuals' work status several years post ABI onset, showing an effect of injury-related and sociodemographic factors. Qualitative studies mostly dealt with work maintenance and revealed a key role of cognitive difficulties, psychological personal factors (e.g., adequate coping strategies) and environmental factors (e.g., flexible work schedules, supportive colleagues). CONCLUSIONS The factors identified in our review should receive particular attention in vocational integration and job retention programs to support work participation of people with ABI in the long term. There is a need for measures that regularly monitor and promote a good match between individuals and their work environment.Implications for RehabilitationPeople with acquired brain injury (ABI) often have long-lasting and invisible injury-related difficulties that hamper their labour market participation.Factors identified as positively associated with working in the long term, such as coping strategies and self-awareness, should be strengthened.Future interventions should educate affected persons, employers and health care professionals about long-lasting injury-related difficulties and promote a supportive work environment for people with ABI.Prolonged availability of vocational services could be beneficial for supporting work maintenance of people with ABI.
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Affiliation(s)
- Katarzyna Karcz
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bruno Trezzini
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Reuben Escorpizo
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Rehabilitation and Movement Science, The University of Vermont, USA
| | - Urban Schwegler
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Monika Finger
- Work and Integration Group, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Polozova Anastasia V, Boyarinov Gennadii A, Nikolsky Viktor O, Zolotova Marina V, Deryugina Anna V. The functional indexes of RBCs and microcirculation in the traumatic brain injury with the action of 2-ethil-6-methil-3-hydroxypiridin succinate. BMC Neurosci 2021; 22:57. [PMID: 34525969 PMCID: PMC8442361 DOI: 10.1186/s12868-021-00657-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
RESEARCH AIM To study the RBCs functional and metabolic parameters and the microcirculatory brain structure at traumatic brain injury (TBI) under the action of 2-ethyl-6-methyl-3-hydroxypyridine succinate. METHODS A closed TBI was modeled by the free fall of a load on the parietooccipital regions of head. We made studies of the influence of 2-ethil-6-methil-3-hydroxipiridin succinate on aggregation and electrophoretic mobility of RBCs, catalase activity, malonic dialdehyde concentration, adenosine triphosphate and 2.3-biphosphoglycerate (2.3 - BPG) concentrations in RBCs. The state of parenchyma and microcirculatory brain mainstream in post-traumatic period of TBI have been studied on micro-preparations. RESULTS The use of 2-ethyl-6-methyl-3-hydroxypyridine succinate under conditions of head injury leads to a decrease in MDA concentration and in aggregation of RBCs, to an increase in the 2.3-BPG concentration and RBC electrophoretic mobility compared to the control (group value). The most pronounced changes under the action of 2-ethyl-6-methyl-3-hydroxypyridine succinate were observed 3-7 days after the TBI. Significant indicators of the restoration of the microvasculature and brain tissue provoked by the use of 2-ethyl-6-methyl-3-hydroxypyridine succinate of were evident from the 7th day unlike the control group, where the restoration of structural morphological parameters was observed only on the 12th day of the post-traumatic period. Fast recovery of blood flow under the action of 2-ethyl-6-methyl-3-hydroxypyridine succinate ensured effective restoration of neurons and glia in comparison with the control group. CONCLUSIONS Early and long-term cytoprotective correction intensifies the oxygen transport function of the blood, prevents and / or reduces disorders of microvessels, neurons and glia in the post-traumatic period, thereby provides correction of hypoxic state and drives to the restoration of brain tissues homeostasis.
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Affiliation(s)
- V Polozova Anastasia
- Department of Physiology and Anatomy, Institute of Biology and Biomedicine, Lobachevsky University, 23 Gagarin Ave., Nizhny Novgorod, Russia. .,Department of Anesthesiology and Intensive Care, Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia.
| | - A Boyarinov Gennadii
- Department of Anesthesiology and Intensive Care, Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
| | - O Nikolsky Viktor
- Department of Anesthesiology and Intensive Care, Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
| | - V Zolotova Marina
- Department of Physiology and Anatomy, Institute of Biology and Biomedicine, Lobachevsky University, 23 Gagarin Ave., Nizhny Novgorod, Russia
| | - V Deryugina Anna
- Department of Physiology and Anatomy, Institute of Biology and Biomedicine, Lobachevsky University, 23 Gagarin Ave., Nizhny Novgorod, Russia
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Libeson L, Ross P, Downing M, Ponsford J. Factors associated with employment stability following traumatic brain injury, in a sample who have received comprehensive vocational rehabilitation. Disabil Rehabil 2021; 44:6325-6332. [PMID: 34498992 DOI: 10.1080/09638288.2021.1965229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To quantify employment stability of individuals with traumatic brain injury (TBI) who received comprehensive vocational rehabilitation (VR) using different measures to identify difficulties experienced and factors associated with employment stability. MATERIALS AND METHODS 72 individuals with predominantly moderate-severe TBI were interviewed. Neuropsychological assessment scores were collected. Three employment stability measures were used: number of post-injury employers, duration with employer and average weekly hours. Descriptive and predictive analyses were performed. RESULTS 90.2% remained employed at time of interview (Mean = 4.83 years post-injury). However, participants worked significantly fewer hours, 63.9% had changed roles or employers at least once and only 51% achieved their pre-injury level of responsibility. 61% reported a high level of employer support. Self-reported difficulties included physical sequelae, memory problems and fatigue. Post-injury testing found impaired memory (34.4%) and processing speed (49.2%). After accounting for time since injury, demographic and employment variables (older age, male gender, higher pre-injury skill-level, higher level of employer support), higher level of injury-related difficulties and lower level of cognitive function significantly predicted employment stability. CONCLUSION Injury-related difficulties impact employment long-term, necessitating ongoing work modifications. Individualised VR is important, not only to facilitate return to work but to support long-term employment stability after TBI.Implications for rehabilitationBeing male was associated with working more hours, and having faster processing speed, lower levels of fatigue and ongoing physical sequelae were associated with a longer duration with the same employer.Initial return to work is often the first step on a long journey as injury-related difficulties can continue to impact work in the-long term and require lasting modifications to duties and working hours.VR should include ongoing follow-up to facilitate work modifications and support both the employer and the employee in adjusting to these.VR should be individualised to support the impact of the unique cognitive and physical limitations experienced by each individual with TBI, based on the needs and employment demands of each workplace.
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Affiliation(s)
- Lauren Libeson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Pamela Ross
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia.,Epworth HealthCare, Richmond, Victoria, Australia
| | - Marina Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
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Eysenbach G, Zhao F, Turkstra L, Toma C, Mutlu B, Duff MC. Computer-Mediated Communication in Adults With and Without Moderate-to-Severe Traumatic Brain Injury: Survey of Social Media Use. JMIR Rehabil Assist Technol 2021; 8:e26586. [PMID: 34448727 PMCID: PMC8433938 DOI: 10.2196/26586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/03/2021] [Accepted: 05/31/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Individuals with a history of traumatic brain injury (TBI) report fewer social contacts, less social participation, and more social isolation than noninjured peers. Cognitive-communication disabilities may prevent individuals with TBI from accessing the opportunities for social connection afforded by computer-mediated communication, as individuals with TBI report lower overall usage of social media than noninjured peers and substantial challenges with accessibility and usability. Although adaptations for individuals with motor and sensory impairments exist to support social media use, there have been no parallel advances to support individuals with cognitive disabilities, such as those exhibited by some people with TBI. In this study, we take a preliminary step in the development process by learning more about patterns of social media use in individuals with TBI as well as their input and priorities for developing social media adaptations. OBJECTIVE This study aims to characterize how and why adults with TBI use social media and computer-mediated communication platforms, to evaluate changes in computer-mediated communication after brain injury, and to elicit suggestions from individuals with TBI to improve access to social media after injury. METHODS We conducted a web-based survey of 53 individuals with a chronic history of moderate-to-severe TBI and a demographically matched group of 51 noninjured comparison peers. RESULTS More than 90% of participants in both groups had an account on at least one computer-mediated communication platform, with Facebook and Facebook Messenger being the most popular platforms in both groups. Participants with and without a history of TBI reported that they use Facebook more passively than actively and reported that they most frequently maintain web-based relationships with close friends and family members. However, participants with TBI reported less frequently than noninjured comparison participants that they use synchronous videoconferencing platforms, are connected with acquaintances on the web, or use social media as a gateway for offline social connection (eg, to find events). Of the participants with TBI, 23% (12/53) reported a change in their patterns of social media use caused by brain injury and listed concerns about accessibility, safety, and usability as major barriers. CONCLUSIONS Although individuals with TBI maintain social media accounts to the same extent as healthy comparisons, some may not use them in a way that promotes social connection. Thus, it is important to design social media adaptations that address the needs and priorities of individuals with TBI, so they can also reap the benefits of social connectedness offered by these platforms. By considering computer-mediated communication as part of individuals' broader social health, we may be able to increase web-based participation in a way that is meaningful, positive, and beneficial to broader social life.
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Affiliation(s)
| | - Fangyun Zhao
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Lyn Turkstra
- Speech-Language Pathology Program, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Catalina Toma
- Department of Communication Arts, University of Wisconsin-Madison, Madison, WI, United States
| | - Bilge Mutlu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Melissa C Duff
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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Vallat-Azouvi C, Swaenepoël M, Ruet A, Bayen E, Ghout I, Nelson G, Pradat-Diehl P, Meaude L, Aegerter P, Charanton J, Jourdan C, Azouvi P. Relationships between neuropsychological impairments and functional outcome eight years after severe traumatic brain injury: Results from the PariS-TBI study. Brain Inj 2021; 35:1001-1010. [PMID: 34283665 DOI: 10.1080/02699052.2021.1933180] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVES The objective was to assess the relationships between neuropsychological impairments, functional outcome and life satisfaction in a longitudinal study of patients after a severe traumatic brain injury (TBI) (PariS-TBI study). PATIENTS Out of 243 survivors, 86 were evaluated 8 years post-injury. They did not significantly differ from patients lost-to-follow up except for the latter being more frequently students or unemployed before the injury. METHODS Outcome measures included the Glasgow Outcome Scale-Extended (GOS-E), a functional independence questionnaire, employment, mood, fatigue and satisfaction with life. Neuropsychological outcome was assessed by two ways: performance-based outcome measures, using neuropsychological tests and patient and relative-based measures. RESULTS Neuropsychological measures were not significantly related to initial injury severity nor to gender, but were significantly related to age and education. After statistical correction for multiple comparisons, cognitive testing and cognitive questionnaires were significantly correlated with most outcome measures. By contrast, satisfaction with life was only related with patient-rated questionnaires. A regression analysis showed that the Trail-Making-Test-A was the best predictor of functional outcome, in addition to education duration. CONCLUSIONS Cognitive measures, particularly slowed information processing speed, were significant indicators of functional outcome at a long-term post-injury, beyond and above demographics or injury severity measures.
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Affiliation(s)
- Claire Vallat-Azouvi
- UR Fonctionnement et Dysfonctionnement Cognitifs : les âges de la vie (DYSCO), Université Paris 8-Saint-Denis, Saint-Denis, France.,Antenne UEROS- UGECAM IDF, Hôpital Raymond Poincaré, Garches, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Swaenepoël
- Antenne UEROS- UGECAM IDF, Hôpital Raymond Poincaré, Garches, France
| | - Alexis Ruet
- Centre Hospitalier Universitaire De Caen, Service De Médecine Physique Et De Réadaptation, Caen, France
| | - Eleonore Bayen
- Assistance Publique-Hôpitaux De Paris, Groupe Hospitalier Pitié-Salpêtrière, Service De Médecine Physique Et Réadaptation, Paris, and Paris Sorbonne Université, Paris, France
| | - Idir Ghout
- Assistance Publique-Hôpitaux De Paris, Hôpital Ambroise Paré, Unité De Recherche Clinique (URC), Boulogne, France
| | - Gaelle Nelson
- Centre Ressources Francilien Du Traumatisme Crânien (CRFTC), Paris, France
| | - Pascale Pradat-Diehl
- Assistance Publique-Hôpitaux De Paris, Groupe Hospitalier Pitié-Salpêtrière, Service De Médecine Physique Et Réadaptation, Paris, and Paris Sorbonne Université, Paris, France
| | - Layide Meaude
- Assistance Publique-Hôpitaux De Paris, Hôpital Ambroise Paré, Unité De Recherche Clinique (URC), Boulogne, France
| | - Philippe Aegerter
- Assistance Publique-Hôpitaux De Paris, Hôpital Ambroise Paré, Unité De Recherche Clinique (URC), Boulogne, France
| | - James Charanton
- Centre Ressources Francilien Du Traumatisme Crânien (CRFTC), Paris, France
| | - Claire Jourdan
- Centre Hospitalier Universitaire De Montpellier, Service De Médecine Physique Et De Réadaptation, Montpellier, France
| | - Philippe Azouvi
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France.,Assistance Publique-Hôpitaux De Paris, Hôpital Raymond Poincaré, Service De Médecine Physique Et De Réadaptation, Garches, France
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Mol TI, van Bennekom CA, Schepers VP, Ter Hoeve N, Kruitwagen-van Reenen ET, Visser-Meily JM, Post MW. Differences in Societal Participation Across Diagnostic Groups: Secondary Analyses of 8 Studies Using the Utrecht Scale for Evaluation of Rehabilitation-Participation. Arch Phys Med Rehabil 2021; 102:1735-1745. [PMID: 33757804 DOI: 10.1016/j.apmr.2021.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine differences in participation problems between diagnostic groups and to examine diagnosis as a determinant of participation with and without statistically accounting for confounders. DESIGN Secondary analyses of data from 8 studies. SETTING Community, the Netherlands. PARTICIPANTS Participants (N=1735) in diagnostic groups: stroke (n=534), subarachnoid hemorrhage (n=104), other acquired brain injury (n=163), progressive neurologic diseases (n=112), acute coronary syndrome (n=536), and spinal cord injury (n=286). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participation was measured with the Utrecht Scale for Evaluation of Rehabilitation-Participation. This measure has 3 scales: Restrictions, Satisfaction, and Frequency. In this study, scores were also computed for 3 domains across these scales: Productivity, Leisure, and Social. Scores ranged from 0 (worst) up to 100 (best). Possible confounders were age, sex, level of education, marital status, and time since onset of the condition. RESULTS Significant differences were found in levels of participation between diagnostic groups. Individuals with acute coronary syndrome showed better participation scores in all scales and domains compared with most or all other diagnostic groups, except for the Social domain. Individuals with progressive neurologic diseases showed the lowest (worst) Restriction and Satisfaction scores, whereas those with stroke showed the lowest Frequency scores. After correcting for confounders, diagnosis explained significant proportions of the variance of participation (Frequency, 6.4%; Restrictions, 15.1%; Satisfaction, 5.1%; Productivity, 13.2%; Leisure, 13.8%; Social, 6.9%). CONCLUSIONS Participation problems occurred in all 6 diagnostic groups within this study. Differences were found in participation between diagnostic groups, demonstrating diagnosis-specific participation profiles, including after correcting for confounders.
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Affiliation(s)
- Tanja I Mol
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen
| | - Coen A van Bennekom
- Heliomare Rehabilitation Center, Research and Development and Institute of Vocational Assessment and Education, Wijk aan Zee; Academic Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam
| | - Vera P Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
| | - Nienke Ter Hoeve
- Capri Cardiac Rehabilitation, Rotterdam; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Esther T Kruitwagen-van Reenen
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
| | - Johanna M Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht
| | - Marcel W Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen.
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Zhang L, Wang H. FTY720 in CNS injuries: Molecular mechanisms and therapeutic potential. Brain Res Bull 2020; 164:75-82. [DOI: 10.1016/j.brainresbull.2020.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/23/2020] [Accepted: 08/15/2020] [Indexed: 12/25/2022]
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Role of LCF scale as an outcome prognostic index in patients with traumatic brain injury. Neurol Sci 2020; 42:2747-2752. [PMID: 33123923 DOI: 10.1007/s10072-020-04852-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
The disabling effects of traumatic brain injuries (TBI) present a significant healthcare concern to developed countries. In order to achieve a reliable prognosis, validated assessment scales are used to monitor the cognitive outcome, like the Level of Cognitive Functioning Scale, or the overall functional outcome, namely the Functional Independence Measure and Glasgow Outcome Scale. The aim of our study was to evaluate the role of Level of Cognitive Functioning Scale (LCF) as an outcome prognostic index in patients with TBI. MATERIALS AND METHODS Fifty-four patients with TBI with a mean age of 44.9 years (SD 20.915) were enrolled in this retrospective study. Patients were evaluated at admission and at discharge using the Glasgow Outcome Scale, Functional Independence Measure, and Level of Cognitive Functioning Scale. The Glasgow Outcome Scale was also implemented at 6 months after discharge (OUTCOME.GOS), whereas the LCF was used twice a week throughout hospitalization. For our purpose, we named LCF at admission LCFa, whereas permanence in the same LCF value (number of days), LCFaL. RESULTS Δ.GOS, Δ.FIM (Δ = difference between value at discharge and at admission), and OUTCOME.GOS were significantly affected by age, length of stay, LCFa, and LCFaL. CONCLUSION The LCF can give a valuable indication to the prognosis of patients with TBI besides monitoring changes in cognitive function. This allows for individual rehabilitation plan, and long-term management strategies could be developed more quickly upon patient's discharge. Consequently, valuable healthcare and social care resources could be assigned correctly.
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Drugs with anti-inflammatory effects to improve outcome of traumatic brain injury: a meta-analysis. Sci Rep 2020; 10:16179. [PMID: 32999392 PMCID: PMC7528105 DOI: 10.1038/s41598-020-73227-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/11/2020] [Indexed: 12/26/2022] Open
Abstract
Outcome after traumatic brain injury (TBI) varies largely and degree of immune activation is an important determinant factor. This meta-analysis evaluates the efficacy of drugs with anti-inflammatory properties in improving neurological and functional outcome. The systematic search following PRISMA guidelines resulted in 15 randomized placebo-controlled trials (3734 patients), evaluating progesterone, erythropoietin and cyclosporine. The meta-analysis (15 studies) showed that TBI patients receiving a drug with anti-inflammatory effects had a higher chance of a favorable outcome compared to those receiving placebo (RR = 1.15; 95% CI 1.01–1.32, p = 0.041). However, publication bias was indicated together with heterogeneity (I2 = 76.59%). Stratified analysis showed that positive effects were mainly observed in patients receiving this treatment within 8 h after injury. Subanalyses by drug type showed efficacy for progesterone (8 studies, RR 1.22; 95% CI 1.01–1.47, p = 0.040), again heterogeneity was high (I2 = 62.92%) and publication bias could not be ruled out. The positive effect of progesterone covaried with younger age and was mainly observed when administered intramuscularly and not intravenously. Erythropoietin (4 studies, RR 1.20; p = 0.110; I2 = 76.59%) and cyclosporine (3 studies, RR 0.75; p = 0.189, I2 = 0%) did not show favorable significant effects. While negative findings for erythropoietin may reflect insufficient power, cyclosporine did not show better outcome at all. Current results do not allow firm conclusions on the efficacy of drugs with anti-inflammatory properties in TBI patients. Included trials showed heterogeneity in methodological and sample parameters. At present, only progesterone showed positive results and early administration via intramuscular administration may be most effective, especially in young people. The anti-inflammatory component of progesterone is relatively weak and other mechanisms than mitigating overall immune response may be more important.
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50
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Brandt E, Wilson JK, Rieger RE, Gill D, Mayer AR, Cavanagh JF. Respiratory Sinus Arrhythmia Correlates With Depressive Symptoms Following Mild Traumatic Brain Injury. J PSYCHOPHYSIOL 2020. [DOI: 10.1027/0269-8803/a000268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Depression is a pervasive psychiatric problem following mild traumatic brain injury (mTBI). However, the onset and course of symptom expression following mTBI can differ from that of spontaneous episodes of depression. Here, we aimed to assess a physiological metric closely linked to depression: respiratory sinus arrhythmia (RSA), a measure of high frequency heart rate variability. RSA is reduced during depressive episodes, and higher resting RSA has been shown to predict future recovery from depression. In this study, we investigated if these patterns were observed throughout the typical timeframe of sub-acute mTBI recovery. Although RSA did not differ between mTBI ( n = 50) and control ( n = 27) groups, depressive symptoms were reliably correlated with RSA only in the mTBI group. This pattern was consistent 2 weeks, 2 months, and 4 months post-injury. Furthermore, resting RSA shortly following injury predicted the trajectory of depressive symptoms 2 months later. These findings generalize the connection between RSA and depression to a clinical population where depressive symptoms are common but often difficult to parse from other post-trauma consequences.
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Affiliation(s)
- Emma Brandt
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
| | - J. Kevin Wilson
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
| | - Rebecca E. Rieger
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
| | - Darbi Gill
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
| | - Andrew R. Mayer
- University of New Mexico Health Sciences Center, Department of Neuroscience, University of New Mexico, Albuquerque, NM, USA
- Mind Research Network, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque NM, USA
| | - James F. Cavanagh
- Department of Psychology, University of New Mexico, Albuquerque NM, USA
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