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Rioux M, Brasher PMA, McKeown G, Yeates KO, Vranceanu AM, Snell DL, Cairncross M, Panenka WJ, Iverson GL, Debert CT, Bayley MT, Hunt C, Burke MJ, Silverberg ND. Graded exposure therapy for adults with persistent symptoms after mTBI: A historical comparison study. Neuropsychol Rehabil 2024:1-17. [PMID: 39330946 DOI: 10.1080/09602011.2024.2403647] [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: 03/06/2024] [Accepted: 09/08/2024] [Indexed: 09/28/2024]
Abstract
Fear avoidance behaviour is associated with slow recovery from mild traumatic brain injury (mTBI). This study is a preliminary evaluation of graded exposure therapy (GET), which directly targets fear avoidance behaviour, for reducing post-concussion symptoms (PCS) and disability following mTBI. In a historical comparison design, we compared two groups from independent randomized trials. The GET + UC group (N = 34) received GET (delivered over 16 videoconference sessions) in addition to usual care (UC). The historical comparison group (N = 71) received UC only. PCS severity (Rivermead Post Concussion Symptoms Questionnaire; RPQ) and disability (World Health Organization Disability Assessment Schedule; WHODAS 2.0 12-item) were measured at clinic intake (M = 2.7, SD = 1.1 months after injury) and again at M = 4.9 (SD = 1.1) months after injury. Between-group differences were estimated using linear mixed effects regression, with a sensitivity analysis controlling for injury-to-assessment intervals. The estimated average change on the RPQ was -14.3 in the GET + UC group and -5.3 in the UC group. The estimated average change on the WHODAS was -5.3 in the GET + UC group and -3.2 in the UC group. Between-group differences post-treatment were -5.3 on the RPQ and -1.5 on the WHODAS. Treatment effects were larger in sensitivity analyses. Findings suggest that a randomized controlled trial is warranted.
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Affiliation(s)
- Mathilde Rioux
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Gabriel McKeown
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Deborah L Snell
- Concussion Clinic, Canterbury District Health Board, Christchurch, New Zealand
- Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - William J Panenka
- British Columbia Neuropsychiatry Program, Vancouver, BC, Canada
- BC Mental Health and Substance Use Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Grant L Iverson
- Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
- Mass General Brigham for Children Sports Concussion Program, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
| | - Chantel T Debert
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, AB, Canada
| | - Mark T Bayley
- Hull-Ellis Concussion Research Clinic, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Cindy Hunt
- Head Injury Clinic, Trauma and Neurosurgery Program, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew J Burke
- Neuropsychiatry Program, Department of Psychiatry and Division of Neurology, Department of Medicine Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Center for Brain Health, University of British Columbia, Vancouver, BC, Canada
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2
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Faulkner JW, Callagher E, Snell D, Nielsen K, Cairncross M, Theadom A. Evaluation of a biopsychosocial education resource for mild traumatic brain injury: a mixed method exploratory study. Front Neurol 2024; 15:1429928. [PMID: 39268065 PMCID: PMC11390456 DOI: 10.3389/fneur.2024.1429928] [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: 05/13/2024] [Accepted: 08/15/2024] [Indexed: 09/15/2024] Open
Abstract
Introduction Education is strongly advocated as a key component of treatment for mild traumatic brain injury (mTBI) in clinical guidelines. However, there is mixed evidence on the benefit of education. This study aimed to evaluate a new education resource for mTBI. CLARITY is a freely available animated video based on a biopsychosocial conceptualization of mTBI, explaining the complex psychological, environmental and biological mechanisms behind symptoms and recovery. Methods 24 adults with a history of mTBI participated in this mixed method study to examine prior experience of mTBI education and to evaluate CLARITY. Following viewing of the education video participants' were invited to engage in a semi-structured interview and to share their perceptions of it via an online anonymous questionnaire. Results Thematic analysis of semi-structured interviews revealed one overarching theme: education is the foundation of recovery. Participants emphasised the critical role of coherent education in facilitating understanding, engagement in rehabilitation, and positive expectations during recovery. However, the first subtheme was that existing foundations are weak. Participants' previous education was often limited in scope, inconsistent, and delivered in inaccessible ways. The second subtheme was that new foundations are stronger. Participants responded positively to CLARITY, highlighting its explanatory biopsychosocial approach, focus on mental health factors and accessible delivery methods as key strengths. Questionnaire responses revealed favourable endorsement of CLARITY's utility, comprehensibility and accessibility. Discussion Recommendations for minor refinements to CLARITY were provided and made, as well as for its use in health care services.
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Affiliation(s)
- Josh W Faulkner
- Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Elise Callagher
- Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Deborah Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Kristopher Nielsen
- Te Herenga Waka-Victoria University of Wellington, Wellington, New Zealand
| | - Molly Cairncross
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
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3
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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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Lu HC, Gevirtz R, Yang CC, Hauson AO. Heart Rate Variability Biofeedback for Mild Traumatic Brain Injury: A Randomized-Controlled Study. Appl Psychophysiol Biofeedback 2023; 48:405-421. [PMID: 37335413 PMCID: PMC10582136 DOI: 10.1007/s10484-023-09592-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
To determine whether heart rate variability biofeedback (HRV-BF) training, compared to a psychoeducation control condition can strengthen the integration of the central and autonomic nervous systems as measured by neuropsychological measures in patients with mild traumatic brain injury (mTBI). Participants were recruited from two university hospitals in Taipei, Taiwan. A total of 49 participants with mTBI were recruited for this study. Forty-one participants completed the study, 21 in the psychoeducation group and 20 in the HRV-BF group. Randomized controlled study. The Taiwanese Frontal Assessment Battery, the Semantic Association of Verbal Fluency Test, the Taiwanese version of the Word Sequence Learning Test, the Paced Auditory Serial Addition Test-Revised, and the Trail Making Test were used as performance-based neuropsychological functioning measures. The Checklist of Post-concussion Symptoms, the Taiwanese version of the Dysexecutive Questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory, and the National Taiwan University Irritability Scale were used as self-report neuropsychological functioning measures. Furthermore, heart rate variability pre- vs. post-training was used to measure autonomic nervous system functioning. Executive, information processing, verbal memory, emotional neuropsychological functioning, and heart rate variability (HRV) were improved significantly in the HRV-BF group at the posttest whereas the psychoeducation group showed no change. HRV biofeedback is a feasible technique following mild TBI that can improve neuropsychological and autonomic nervous system functioning. HRV-BF may be clinically feasible for the rehabilitation of patients with mTBI.
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Affiliation(s)
- Hsueh Chen Lu
- California School of Professional Psychology at Alliant International University, Clinical Psychology PhD Program, San Diego, CA, USA
| | - Richard Gevirtz
- California School of Professional Psychology at Alliant International University, Clinical Psychology PhD Program, San Diego, CA, USA.
| | - Chi Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Alexander O Hauson
- California School of Professional Psychology at Alliant International University, Clinical Psychology PhD Program, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.Org), San Diego, CA, USA
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5
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Does insecure attachment affect treatment outcome in young persons with post-concussion symptoms? A secondary analysis of the GAIN trial. J Psychosom Res 2023; 164:111100. [PMID: 36502555 DOI: 10.1016/j.jpsychores.2022.111100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/27/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
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6
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Belanger HG, Toyinbo P, Barrett B, King E, Sayer NA. Concussion coach for postconcussive symptoms: A randomized, controlled trial of a smartphone application with Afghanistan and Iraq war Veterans. Clin Neuropsychol 2022; 36:2093-2119. [PMID: 34184976 DOI: 10.1080/13854046.2021.1936188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: Investigate the effectiveness of Concussion Coach, an interactive smartphone application, as a treatment for residual neurobehavioral symptoms and distress in Veterans with a history of mild traumatic brain injury (mild TBI). Methods: Veterans with mild TBI were randomized to Concussion Coach (n = 238) or Treatment-as-Usual (TAU) (n = 241) in a 3-month randomized controlled trial. Primary outcome measures included postconcussive symptom (PCS) severity as measured by the Neurobehavioral Symptom Inventory (NSI), and psychological distress as measured by the Brief Symptom Inventory-18 (BSI-18). Measures of self-efficacy, social support, and comfort with technology were administered as potential moderators and mediators. An intention-to-treat (ITT) analysis was performed (N = 461: Concussion Coach = 231 and TAU = 230) using Bayesian Network (BN)modeling. Results: The probability of decreased PCS severity was significantly greater for those assigned to Concussion Coach, .35 [.32,.37], than for TAU, .29 (.27, .32), with an odds ratio (OR) of 1.29. Also, Concussion Coach showed a significantly greater probability of increased self-efficacy (.36 [.32, .39]) than did TAU (.28 [.25, .30], OR = 1.42). In turn, self-efficacy (increased vs. decreased) showed a significantly greater probability of decreased PCS severity (.51 [.47, .54] vs. .27 [.24, .30], OR = 2.71) and decreased psychological distress (.53 [.49, .56] vs. .32 [.29, .35], OR = 2.35), suggesting that self-efficacy may have mediated Concussion Coach effects. Conclusions: Concussion Coach is effective at reducing PCS severity and psychological distress. Increased self-efficacy/perception of self-management of symptoms may be key to successful treatment of residual symptoms in those with history of concussion.
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Affiliation(s)
- Heather G Belanger
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA.,United States Special Operations Command (USSOCOM), Tampa, FL, USA.,Department of Psychology and Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,St Michael's Inc, Tampa, FL, USA
| | - Peter Toyinbo
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Blake Barrett
- Research and Development Service, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | | | - Nina A Sayer
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System and Departments of Medicine and Psychiatry, University of Minnesota, Minneapolis, MN, USA
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Næss-Schmidt ET, Thastum MM, Stabel HH, Odgaard L, Pedersen AR, Rask CU, Silverberg ND, Schröder A, Nielsen JF. Interdisciplinary intervention (GAIN) for adults with post-concussion symptoms: a study protocol for a stepped-wedge cluster randomised trial. Trials 2022; 23:613. [PMID: 35906645 PMCID: PMC9338593 DOI: 10.1186/s13063-022-06572-7] [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] [Received: 05/29/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Persistent post-concussion symptoms (PCS) are associated with prolonged disability, reduced health-related quality of life and reduced workability. At present, no strong evidence for treatments for people with persistent PCS exists. Our research group developed a novel intervention, “Get going After concussIoN (GAIN)”, that incorporates multiple evidence-based strategies including prescribed exercise, cognitive behavioural therapy, and gradual return to activity advice. In a previous randomised trial, GAIN provided in a hospital setting was effective in reducing symptoms in 15–30-year-olds with PCS 2–6 months post-injury. In the current study, we describe the protocol for a trial designed to test the effectiveness of GAIN in a larger municipality setting. Additionally, we test the intervention within a broader age group and evaluate a broader range of outcomes. The primary hypothesis is that participants allocated to enhanced usual care plus GAIN report a higher reduction in PCS 3 months post-intervention compared to participants allocated to enhanced usual care only. Methods The study is a stepped-wedge cluster-randomised trial with five clusters. The 8-week interdisciplinary GAIN program will be rolled out to clusters in 3-month intervals. Power calculation yield at least 180 participants to be enrolled. Primary outcome is mean change in PCS measured by the Rivermead Post-Concussion Symptoms Questionnaire from enrolment to 3 months after end of treatment. Secondary outcomes include participation in and satisfaction with everyday activities, labour market attachment and other behavioural measures. Self-reported outcomes are measured at baseline, by end of treatment and at 3, 6, and 18 months after end of treatment. Registry-based outcomes are measured up to 36 months after concussion. Discussion The trial will provide important information concerning the effectiveness of the GAIN intervention in a municipality setting. Furthermore, it will provide knowledge of possible barriers and facilitators that may be relevant for future implementation of GAIN in different settings. Trial registration The current GAIN trial is registered in ClinicalTrials.gov (study identifier: NCT04798885) on 20 October 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06572-7.
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Affiliation(s)
- Erhard Trillingsgaard Næss-Schmidt
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark. .,Department of Clinical Medicine, AU, Aarhus, Denmark.
| | - Mille Møller Thastum
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark
| | - Henriette Holm Stabel
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark
| | - Lene Odgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark
| | - Asger Roer Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, AU, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Clinical Medicine, AU, Aarhus, Denmark.,Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Andreas Schröder
- Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, AU, Aarhus, Denmark
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Fink SJ, Davey DK, Sakamoto MS, Chanfreau-Coffinier C, Clark AL, Delano-Wood L, Merritt VC. Subjective cognitive and psychiatric well-being in U.S. Military Veterans screened for deployment-related traumatic brain injury: A Million Veteran Program Study. J Psychiatr Res 2022; 151:144-149. [PMID: 35483132 PMCID: PMC9406238 DOI: 10.1016/j.jpsychires.2022.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/30/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine subjective cognitive and psychiatric functioning in post-deployed military Veterans who underwent the Veterans Health Administration's Traumatic Brain Injury (TBI) Screening and Evaluation Program and enrolled in the VA's Million Veteran Program (MVP). Veterans (N = 7483) were classified into three groups based on outcomes from the TBI Screening and Evaluation Program: (1) negative TBI screen ('Screen-'), (2) positive TBI screen but no TBI diagnosis ('Screen+/TBI-'), or (3) positive TBI screen and TBI diagnosis ('Screen+/TBI+'). Chi-square analyses revealed significant group differences across all self-reported cognitive and psychiatric health conditions (e.g., memory loss, depression), and ANCOVAs similarly showed a significant association between group and subjective symptom reporting. Specifically, the relationship between TBI group and clinical outcome (i.e., health conditions and symptoms) was such that the Screen+/TBI+ group fared the worst, followed by the Screen+/TBI- group, and finally the Screen- group. However, evaluation of effect sizes suggested that Veterans in the two Screen+ groups (Screen+/TBI+ and Screen+/TBI-) are faring similarly to one another on subjective cognitive and psychiatric functioning, but that both Screen+ groups are faring significantly worse than the Screen- group. Our results have meaningful clinical implications and suggest that Veterans who screen positive for TBI, regardless of ultimate TBI diagnosis, be eligible for similar clinical services so that both groups can benefit from valuable treatments and therapeutics. Finally, this research sets the stage for follow-up work to be conducted within MVP that will address the neurobiological underpinnings of cognitive and psychiatric distress in this population.
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Affiliation(s)
- Shayna J Fink
- Veterans Medical Research Foundation, San Diego, CA, United States
| | - Delaney K Davey
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - McKenna S Sakamoto
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States
| | - Catherine Chanfreau-Coffinier
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
| | - Lisa Delano-Wood
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States
| | - Victoria C Merritt
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States.
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9
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Shore J, Nalder E, Hutchison M, Reed N, Hunt A. Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development. JMIR Pediatr Parent 2022; 5:e34822. [PMID: 35377326 PMCID: PMC9016504 DOI: 10.2196/34822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. OBJECTIVE This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. METHODS The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. RESULTS Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. CONCLUSIONS The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach.
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Affiliation(s)
- Josh Shore
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Emily Nalder
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Michael Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anne Hunt
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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10
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Faulkner JW, Snell DL, Shepherd D, Theadom A. Turning away from sound: The role of fear avoidance in noise sensitivity following mild traumatic brain injury. J Psychosom Res 2021; 151:110664. [PMID: 34749069 DOI: 10.1016/j.jpsychores.2021.110664] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Noise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS. METHOD Adults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current post-concussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury). RESULTS A pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (β = 0.45, p = .01), as well as stress (β = 0.07, p = .01) and PTSD symptoms (β = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS. CONCLUSIONS Fear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI.
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Affiliation(s)
- Josh W Faulkner
- Massey University, PO Box 756, Wellington 6140, New Zealand.
| | - Deborah L Snell
- University of Otago Christchurch, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Daniel Shepherd
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
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Rytter HM, Graff HJ, Henriksen HK, Aaen N, Hartvigsen J, Hoegh M, Nisted I, Næss-Schmidt ET, Pedersen LL, Schytz HW, Thastum MM, Zerlang B, Callesen HE. Nonpharmacological Treatment of Persistent Postconcussion Symptoms in Adults: A Systematic Review and Meta-analysis and Guideline Recommendation. JAMA Netw Open 2021; 4:e2132221. [PMID: 34751759 PMCID: PMC8579233 DOI: 10.1001/jamanetworkopen.2021.32221] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Persistent (>4 weeks) postconcussion symptoms (PPCS) are challenging for both patients and clinicians. There is uncertainty about the effect of commonly applied nonpharmacological treatments for the management of PPCS. OBJECTIVE To systematically assess and summarize evidence for outcomes related to 7 nonpharmacological interventions for PPCS in adults (aged >18 years) and provide recommendations for clinical practice. DATA SOURCES Systematic literature searches were performed via Embase, MEDLINE, PsycINFO, CINAHL, PEDro, OTseeker, and Cochrane Reviews (via MEDLINE and Embase) from earliest possible publication year to March 3, 2020. The literature was searched for prior systematic reviews and primary studies. To be included, studies had to be intervention studies with a control group and focus on PPCS. STUDY SELECTION A multidisciplinary guideline panel selected interventions based on frequency of use and need for decision support among clinicians, including early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of neck and back, oculomotor vision treatment, psychological treatment, and interdisciplinary coordinated rehabilitative treatment. To be included, studies had to be intervention studies within the areas of the predefined clinical questions, include a control group, and focus on symptoms after concussion or mild traumatic brain injury. DATA EXTRACTION AND SYNTHESIS Extraction was performed independently by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for data abstraction and data quality assessment. Included studies were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool and the Cochrane Risk of Bias (randomized clinical trials) tool. Meta-analysis was performed for all interventions where possible. Random-effects models were used to calculate pooled estimates of effects. The level and certainty of evidence was rated and recommendations formulated according to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. MAIN OUTCOMES AND MEASURES All outcomes were planned before data collection began according to a specified protocol. The primary outcomes were the collective burden of PPCS and another outcome reflecting the focus of a particular intervention (eg, physical functioning after graded exercise intervention). RESULTS Eleven systematic reviews were identified but did not contribute any primary studies; 19 randomized clinical trials comprising 2007 participants (1064 women [53.0%]) were separately identified and included. Evidence for the 7 interventions ranged from no evidence meeting the inclusion criteria to very low and low levels of evidence. Recommendations were weak for early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of the neck and back, psychological treatment, and interdisciplinary coordinated rehabilitative treatment. No relevant evidence was identified for oculomotor vision treatment, so the panel provided a good clinical practice recommendation based on consensus. CONCLUSIONS AND RELEVANCE Based on very low to low certainty of evidence or based on consensus, the guideline panel found weak scientific support for commonly applied nonpharmacological interventions to treat PPCS. Results align with recommendations in international guidelines. Intensified research into all types of intervention for PPCS is needed.
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Affiliation(s)
- Hana Malá Rytter
- Danish Concussion Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Henriette K. Henriksen
- Danish Concussion Center, Copenhagen, Denmark
- Center for Rehabilitation of Brain Injury, Copenhagen, Denmark
| | - Nicolai Aaen
- The Danish Concussion Association, Copenhagen, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Morten Hoegh
- Musculoskeletal Health and Implementation, Department of Medicine, Aalborg University, Aalborg, Denmark
- Pain Science Educator, Aarhus, Denmark
| | - Ivan Nisted
- Danish College of Optometry, Dania Academy, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Henrik Winther Schytz
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Mille Møller Thastum
- Hammel Neurorehabilitation Centre–University Clinic for Neurorehabilitation, Aarhus University, Aarhus, Denmark
| | - Bente Zerlang
- Exercise and Health Training Center, Roskilde Municipality, Roskilde, Denmark
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12
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Tuborgh A, Svendsen SW, Elklit A, Hunter J, Jensen JS, Schröder A, Nielsen JF, Thastum MM, Næss-Schmidt ET, Rask CU. Attachment and symptom reporting in adolescents and young adults after a concussion. J Psychosom Res 2021; 150:110603. [PMID: 34509710 DOI: 10.1016/j.jpsychores.2021.110603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of hospital-treated concussion is 100-300/100,000 person years. Reporting of long-lasting post-concussion symptoms (PCS) is estimated at 5-15%. Attachment insecurity is a potential vulnerability factor for physical illness and poorer disease outcomes in general. This study aimed to explore associations between attachment insecurity and PCS in young people sustaining a concussion. METHODS This cross-sectional study was embedded in a cohort of 15-30-year-old patients (n = 3080) 3 months after sustaining a concussion. Data were obtained from a database and questionnaires. PCS were measured by the Rivermead Post-Concussion Symptoms Questionnaire and attachment dimensions (anxiety and avoidance) by the Experiences in Close Relationships-Relationship Structures Questionnaire. Multiple linear regression models were performed to investigate the association between the attachment dimensions and PCS with adjustment for demographic, injury-related and psychological factors and with additional testing for interaction between the attachment dimensions. RESULTS In the final study sample, comprising 973 patients (31.6%), we found an interaction between the attachment dimensions. Hence, the effect of attachment anxiety on PCS was statistically insignificant at low avoidance (25th percentile) but significant at high avoidance (75th percentile, β = 0.64 (95%CI: 0.02; 1.26)), whereas the effect of attachment avoidance was significant regardless of level of attachment anxiety (25th percentile, β = 1.09 (95%CI: 0.18; 2.01); 75th percentile, β = 2.71 (95%CI: 1.80; 3.61)). CONCLUSION Attachment insecurity, especially characterised by high avoidance in combination with high anxiety, also called fearful attachment, is associated with PCS. Considering the attachment perspective can potentially improve health care for this patient group.
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Affiliation(s)
- A Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - S W Svendsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark; Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Department of Public Health, Section of Environmental Health, University of Copenhagen, Denmark
| | - A Elklit
- Department of Psychology, National Centre of Psycho-traumatology, University of Southern Denmark, Denmark
| | - J Hunter
- Department of Psychiatry, Sinai Health System, University of Toronto, Canada
| | - J S Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - A Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - J F Nielsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark
| | - M M Thastum
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark; Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - E T Næss-Schmidt
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark
| | - C U Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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13
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Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2021; 103:1222-1232. [PMID: 34516996 DOI: 10.1016/j.apmr.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/13/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
Abstract
A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where "psychoeducation" was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation-the Rehabilitation Treatment Specification System-can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.
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14
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Pharmacotherapy for Treatment of Cognitive and Neuropsychiatric Symptoms After mTBI. J Head Trauma Rehabil 2021; 35:76-83. [PMID: 31834058 DOI: 10.1097/htr.0000000000000537] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Cognitive and neuropsychiatric symptoms are extremely common following mild traumatic brain injury (TBI), also known as concussion. Although most patients will recovery rapidly, a significant minority go on to experience persistent symptoms. There are currently no FDA-approved medications for treatment of cognitive and neuropsychiatric problems in the context of mild TBI, yet a number of agents are prescribed "off-label" for these complaints. Rigorous trials are lacking, but there are a number of open-label studies, and some small randomized controlled trials that support the safety and possible efficacy of pharmacotherapies in this population. Clinical trials conducted in samples with more severe brain injuries can also serve as a guide. METHODS Review of the literature. RESULTS & CONCLUSIONS There is the most support in the literature for the neurostimulant methylphenidate for treatment of mild TBI-related cognitive dysfunction, and the selective serotonin reuptake inhibitor, sertraline, for the treatment of postinjury depression. There is clearly a need for more well-designed studies to guide clinicians in selecting the appropriate medication and dose. Without clear guidance from the literature, a cautious approach of starting low and titrating slowly is recommended.
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15
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Shirvani S, Davoudi M, Shirvani M, Koleini P, Hojat Panah S, Shoshtari F, Omidi A. Comparison of the effects of transcranial direct current stimulation and mindfulness-based stress reduction on mental fatigue, quality of life and aggression in mild traumatic brain injury patients: a randomized clinical trial. Ann Gen Psychiatry 2021; 20:33. [PMID: 34130721 PMCID: PMC8207739 DOI: 10.1186/s12991-021-00355-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rate of traumatic brain injuries (TBIs) due to the accidents is high around the world. Patients with mild TBIs may suffer from some psychological disorders, including aggression, and mental fatigue, and thus their quality of life decreased. Among different treatments for TBI, two treatments, namely transcranial direct current stimulation (tDCS), and mindfulness-based stress reduction (MBSR) have shown to be effective. Therefore, this study aimed to compare the effects of these two treatments on mental fatigue, aggression and quality of life in mTBI patients. MATERIALS AND METHODS This randomized controlled trial study was conducted on 48 TBI patients referred to emergency and neurosurgery departments of Shahid Beheshti Hospital, Kashan, Iran. They were selected using the convenience sampling method. Data were collected using the mental fatigue scale, the World Health Organization Quality of Life-BREF (short version), and the Buss-Perry Aggression Questionnaires. Then, the data were analyzed using a Mixed Repeated Measures ANOVAs, and the Levene and Kolmogorov-Smirnov tests by SPSS-23 software. RESULTS The mean age of patients in the three groups of MBSR, tDCS and control were 69.38 + 6.11 (25% male), 25.40 + 12.11 (25% male) and 69.37 + 0.2 (18.8% male), respectively. There was no significant difference between the three groups in terms of mental fatigue, quality of life and aggression (P < 0.05). In addition, the results showed that there was a significant difference between the main effect of time and the interaction between time and group (P < 0.001). CONCLUSIONS Both MBSR and tDCS methods are effective in reducing the mental fatigue and aggression and increasing quality of life of mTBI patients; MBSR treatment, as indicated in the present study, can be more effective than tDCS in patients with mTBI. TRIAL REGISTRATION Thailand Registry of Clinical Trials, TCTR20180827003 Registered on August 24, 2018.
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Affiliation(s)
- Sheida Shirvani
- Department of Clinical Psychology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammadreza Davoudi
- Department of Clinical Psychology, Faculty of Behavioral Science, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Peiman Koleini
- Department of Dental Surgery, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Safora Hojat Panah
- Department of Clinical Psychology, University of Najaf Abad, Isfahan, Iran
| | - Fatemeh Shoshtari
- Department of Clinical Psychology, University of Najaf Abad, Isfahan, Iran
| | - Abdollah Omidi
- Department of Clinical Psychology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
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16
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Feinberg C, Carr C, Zemek R, Yeates KO, Master C, Schneider K, Bell MJ, Wisniewski S, Mannix R. Association of Pharmacological Interventions With Symptom Burden Reduction in Patients With Mild Traumatic Brain Injury: A Systematic Review. JAMA Neurol 2021; 78:596-608. [PMID: 33464290 DOI: 10.1001/jamaneurol.2020.5079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Mild traumatic brain injury (TBI) is experienced by 55.9 million people globally each year. The symptoms of mild TBI are diverse and sometimes long-lasting, requiring frequent use of pharmacological interventions to mitigate them. A thorough understanding of the data supporting pharmacological interventions is important for decision-making among clinicians treating this common injury. Objective To systematically review studies of pharmacological interventions and their associations with symptom burden reduction among patients with mild TBI and to use an evidence-based model to identify potential directions for future research that may aid in clinical decision-making. Evidence Review A systematic review was performed in PubMed, Scopus, and Web of Science. Search strings modified for the advanced search interfaces of each search engine were developed in consultation with a librarian and included combinations of search terms, such as brain concussion, post-concussion syndrome, mild traumatic brain injury, and pharmacological treatment. Articles published between January 1, 2000, and July 1, 2020, were analyzed. Studies were included if (1) they were clinical studies with discrete analyses of participants with mild TBI or complicated mild TBI, (2) they were assessments of a pharmacological intervention, (3) they included human participants, and (4) they were published in a peer-reviewed journal in the English language. Studies were excluded if the severity of TBI among participants could not be ascertained (ie, inadequate definition of mild TBI) and the inclusion criteria for the study required intracranial hemorrhage. A total of 23 studies examining 20 pharmacological interventions met the inclusion criteria. Risk of bias was assessed using the Cochrane Risk of Bias for Randomized Trials (for randomized clinical trials) and the Cochrane Risk of Bias in Non-Randomized Studies of Interventions (for all other studies). Data were analyzed from June to September 2020. Findings A total of 1495 articles were identified; of those, 131 articles were excluded as duplicates. Titles and abstracts were screened for inclusion and exclusion criteria among the remaining 1364 articles, and 134 of those articles received a full-text review. After exclusions, 23 studies (11 randomized clinical trials, 7 prospective observational studies, 3 retrospective observational studies, and 2 case studies) examining 20 pharmacological interventions were identified for inclusion in the systematic review. Studies included 22 distinct participant populations comprising 8277 participants with mild TBI and 45 participants without TBI. Among 23 total studies, 8 studies specifically addressed the pediatric population, 9 studies had a low risk of bias, and 16 studies reported symptom burden reduction. Of the 20 pharmacological interventions examined in the studies, methylphenidate, sertraline hydrochloride, ondansetron, amitriptyline, and melatonin were the only medications included in multiple studies. Conclusions and Relevance This systematic review found a limited number of high-quality, clinically meaningful studies, particularly among children and individuals in the acute stage of injury; therefore, performing an evidence-based analysis that would inform clinical decision-making was not possible. Future studies are needed to focus on standardizing measures and increasing sample sizes (including large multicenter clinical trials) to generate a body of research that may provide additional options for the treatment of patients with mild TBI.
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Affiliation(s)
| | | | - Roger Zemek
- Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Department of Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Master
- Sports Medicine and Performance Center, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Orthopaedics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michael J Bell
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia
| | - Stephen Wisniewski
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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17
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The power of appraisals in predicting PTSD symptom improvement following cognitive rehabilitation: A randomized clinical trial. J Affect Disord 2021; 282:561-573. [PMID: 33440301 DOI: 10.1016/j.jad.2020.12.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/03/2020] [Accepted: 12/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with PTSD often voice concern over their perceived change in cognitive functioning. However, these negative appraisals do not always align with objective neuropsychological performance, yet are strongly predictive of PTSD symptom severity and self-reported functional impairment. METHODS The present study involves a secondary analysis examining the role of appraisals of a subsample of 81 adults with full or subthreshold PTSD on treatment outcomes in a randomized controlled trial investigating the effectiveness of a cognitive rehabilitation treatment, Strategic Memory and Reasoning Training (n = 38), compared to a psychoeducation control arm, the Brain Health Workshop (n = 43). Neither condition addressed PTSD symptoms, focusing instead on cognitive skills training and psychoeducation about the brain. RESULTS Intent-to-treat models showed statistically significant improvements for both groups on composite scores of executive functioning and memory. Additionally, both groups experienced clinically significant reductions in PTSD symptoms (assessed via the Clinician-Administered PTSD Interview) and the SMART group showed fewer negative appraisals about cognitive functioning following training. Change in appraisals of cognitive functioning was associated with change in PTSD as well as change in quality of life, with no differential associations based on group status. In contrast, neurocognitive test score changes were not associated with change in symptoms or functional outcomes. LIMITATIONS We did not collect data on other appraisals (e.g., self-efficacy), which could have further elucidated pathways of change. CONCLUSIONS Our findings suggest that interventions that do not directly target PTSD symptoms can lead to PTSD symptom change via change in appraisals of functioning.
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18
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Trillingsgaard Naess-Schmidt E, Udby Blicher J, Møller Thastum M, Ulrikka Rask C, Wulff Svendsen S, Schröder A, Høgh Tuborgh A, Østergaard L, Sangill R, Lund T, Nørhøj Jespersen S, Roer Pedersen A, Hansen B, Fristed Eskildsen S, Feldbaek Nielsen J. Microstructural changes in the brain after long-term post-concussion symptoms: A randomized trial. J Neurosci Res 2020; 99:872-886. [PMID: 33319932 DOI: 10.1002/jnr.24773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 01/17/2023]
Abstract
A recent randomized controlled trial in young patients with long-term post-concussion symptoms showed that a novel behavioral intervention "Get going After concussIoN" is superior to enhanced usual care in terms of symptom reduction. It is unknown whether these interventional effects are associated with microstructural brain changes. The aim of this study was to examine whether diffusion-weighted MRI indices, which are sensitive to the interactions between cellular structures and water molecules' Brownian motion, respond differently to the interventions of the above-mentioned trial and whether such differences correlate with the improvement of post-concussion symptoms. Twenty-three patients from the intervention group (mean age 22.8, 18 females) and 19 patients from the control group (enhanced usual care) (mean age 23.9, 14 females) were enrolled. The primary outcome measure was the mean kurtosis tensor, which is sensitive to the microscopic complexity of brain tissue. The mean kurtosis tensor was significantly increased in the intervention group (p = 0.003) in the corpus callosum but not in the thalamus (p = 0.78) and the hippocampus (p = 0.34). An increase in mean kurtosis tensor in the corpus callosum tended to be associated with a reduction in symptoms, but this association did not reach significance (p = 0.059). Changes in diffusion tensor imaging metrics did not differ between intervention groups and were not associated with symptoms. The current study found different diffusion-weighted MRI responses from the microscopic cellular structures of the corpus callosum between patients receiving a novel behavioral intervention and patients receiving enhanced usual care. Correlations with improvement of post-concussion symptoms were not evident.
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Affiliation(s)
- Erhard Trillingsgaard Naess-Schmidt
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Health, Aarhus University, Aarhus, Denmark
| | - Jakob Udby Blicher
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Mille Møller Thastum
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Health, Aarhus University, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Susanne Wulff Svendsen
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Høgh Tuborgh
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Leif Østergaard
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ryan Sangill
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Torben Lund
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Sune Nørhøj Jespersen
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - Asger Roer Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Health, Aarhus University, Aarhus, Denmark
| | - Brian Hansen
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Simon Fristed Eskildsen
- Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Jørgen Feldbaek Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.,Department of Clinical Health, Aarhus University, Aarhus, Denmark
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19
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Samuelson KW, Engle K, Abadjian L, Jordan J, Bartel A, Talbot M, Powers T, Bryan L, Benight C. Cognitive Training for Mild Traumatic Brain Injury and Posttraumatic Stress Disorder. Front Neurol 2020; 11:569005. [PMID: 33324318 PMCID: PMC7726225 DOI: 10.3389/fneur.2020.569005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/23/2020] [Indexed: 01/17/2023] Open
Abstract
Although there is evidence of mild cognitive impairments for many individuals with mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD), little research evaluating the effectiveness of cognitive training interventions has been conducted. This randomized controlled trial examined the effectiveness of a 9-h group cognitive training targeting higher-order functions, Strategic Memory Advanced Reasoning Training (SMART), compared to a 9-h psychoeducational control group in improving neurocognitive functioning in adults with mTBI and PTSD. A sample of 124 adults with histories of mild TBI (n = 117) and/or current diagnoses of PTSD (n = 84) were randomized into SMART (n = 66) or Brain Health Workshop (BHW; n = 58) and assessed at three time points: baseline, following training, and 6 months later. Participants completed a battery of neurocognitive tests, including a test of gist reasoning (a function directly targeted by SMART) as well as tests of verbal, visual, and working memory and executive functioning, functions commonly found to be mildly impaired in mTBI and PTSD. The two groups were compared on trajectories of change over time using linear mixed-effects models with restricted maximum likelihood (LMM). Contrary to our hypothesis that SMART would result in superior improvements compared to BHW, both groups displayed statistically and clinically significant improvements on measures of memory, executive functioning, and gist reasoning. Over 60% of the sample showed clinically significant improvements, indicating that gains can be found through psychoeducation alone. A longer SMART protocol may be warranted for clinical samples in order to observe gains over the comparison group.
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Affiliation(s)
- Kristin W Samuelson
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Krista Engle
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Linda Abadjian
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Joshua Jordan
- Department of Psychiatry, University of California San Francisco, San Francisco, San Francisco, CA, United States
| | - Alisa Bartel
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Margaret Talbot
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Tyler Powers
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Lori Bryan
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Charles Benight
- Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
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20
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Merritt VC, Jurick SM, Sakamoto MS, Crocker LD, Sullan MJ, Hoffman SN, Davey DK, Jak AJ. Post-concussive symptom endorsement and symptom attribution following remote mild traumatic brain injury in combat-exposed Veterans: An exploratory study. J Psychiatr Res 2020; 130:224-230. [PMID: 32846326 DOI: 10.1016/j.jpsychires.2020.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/24/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to examine rates of and relationships between "post-concussive" symptom endorsement and symptom attribution in Veterans with a history of mild traumatic brain injury (mTBI). This cross-sectional, exploratory study included 48 combat-exposed Iraq/Afghanistan Veterans with remote history of mTBI. All Veterans completed clinical interviews and self-report questionnaires assessing sociodemographic factors, injury and combat-related variables, psychiatric distress, self-efficacy, and coping style. To assess symptom endorsement and symptom attribution, a modified version of the Neurobehavioral Symptom Inventory was administered. Results showed that the most commonly endorsed "post-concussive" symptoms were several non-specific symptoms, while the symptoms most frequently attributed to mTBI included forgetfulness, poor concentration, and headaches. Furthermore, although there were some overlapping correlates of both symptom endorsement and symptom attribution, unique variables were associated with each domain. Specifically, symptom endorsement was uniquely associated with measures of psychiatric distress, while symptom attribution was uniquely associated with having a history of loss of consciousness and a greater degree of combat exposure. Taken together, results suggest that endorsement of symptoms may be significantly impacted by the presence of mental health comorbidities, but that perceptions or beliefs as to why symptoms are occurring are related more to mTBI and combat-related characteristics. Findings offer potential avenues for therapeutic intervention, emphasize the importance of psychoeducation, and highlight the need to consider using alternate terminology for these symptoms that promotes recovery and minimizes misattribution of symptoms.
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Affiliation(s)
- Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States.
| | - Sarah M Jurick
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States.
| | - McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States.
| | - Laura D Crocker
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States.
| | - Molly J Sullan
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States.
| | - Samantha N Hoffman
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States.
| | - Delaney K Davey
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States.
| | - Amy J Jak
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, United States; Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, United States; Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States.
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21
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Robinson-Freeman KE, Collins KL, Garber B, Terblanche R, Risling M, Vermetten E, Besemann M, Mistlin A, Tsao JW. A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI. Front Neurol 2020; 11:836. [PMID: 32982907 PMCID: PMC7477387 DOI: 10.3389/fneur.2020.00836] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whether exposure to a primary blast wave alone is sufficient to create brain injury in humans, and if so, exactly how this occurs with an intact skull. Resources dedicated to research in this area have also varied substantially among contributing NATO countries. Most of the research has been conducted in the US, focused on addressing uncertainties in management practices. Development of objective diagnostic tests should be a top priority to facilitate both diagnosis and prognosis, thereby improving management. It is expected that blast exposure and blunt force trauma to the head will continue to be a potential source of injury during future conflicts. An improved understanding of the effects of blast exposure will better enable military medical providers to manage mTBI cases and develop optimal protective measures. Without the immediate pressures that come with a high operational tempo, the time is right to look back at lessons learned, make full use of available data, and modify mitigation strategies with both available evidence and new evidence as it comes to light. Toward that end, leveraging our cooperation with the civilian medical community is critical because the military experience over the past 10 years has led to a renewed interest in many similar issues pertaining to mTBI in the civilian world. Such cross-fertilization of knowledge will undoubtedly benefit all. This paper highlights similarities and differences in approach to mTBI patient care in NATO and partner countries and provides a summary of and lessons learned from a NATO lecture series on the topic of mTBI, demonstrating utility of having patients present their experiences to a medical audience, linking practical clinical care to policy approaches.
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Affiliation(s)
| | - Kassondra L Collins
- Department of Physical Therapy, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bryan Garber
- Research and Analysis Section, Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Ronel Terblanche
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Marten Risling
- Department of Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Eric Vermetten
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Markus Besemann
- Physical Medicine and Rehabilitation, Canadian Forces Health Services Group, Ottawa, ON, Canada
| | - Alan Mistlin
- Centre for Mental and Cognitive Health, DMRC Headey Court, Epsom, United Kingdom
| | - Jack W Tsao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States.,Le Bonheur Children's Hospital, Children's Foundation Research Institute, Memphis, TN, United States
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22
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Teo SH, Fong KNK, Chen Z, Chung RCK. Cognitive and psychological interventions for the reduction of post-concussion symptoms in patients with mild traumatic brain injury: a systematic review. Brain Inj 2020; 34:1305-1321. [PMID: 32772725 DOI: 10.1080/02699052.2020.1802668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/01/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the effects of cognitive and psychological interventions for the reduction of post-concussion symptoms (PCS) in patients with mild traumatic brain injury (MTBI). DATA SOURCES The databases of CINAHL, Medline, PubMed, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews. REVIEW METHODS Meta-analysis was conducted for randomized-controlled trials that have included an assessment of PCS using the Rivermead Post-concussion Symptoms Questionnaire as primary outcomes by calculating the mean difference/standardized mean difference using fixed/random effect models as appropriate. RESULTS Systematic review with the date of the last search in Mar 2018 yielded 16080 articles, 17 articles including 3081 participants were included in the final review. Interventions included psychoeducation (n = 8), telephone problem-solving treatment (n = 4), individual-based cognitive behavioral therapy (n = 4), and cognitive training (n = 1). No intervention is effective in reducing PCS at 3 to 6 months follow-up, however, an overall small effect size was found in pooled functional outcomes at 6 months. CONCLUSIONS There was no effect on symptom reduction at 3 to 6 months for PCS interventions but improved functional outcomes were shown for patients with MTBI at 6 months. Long-lasting effects of interventions at 12 months or after were not studied.
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Affiliation(s)
- Sock Hong Teo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University , Hong Kong SAR
- National University Hospital , Singapore
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University , Hong Kong SAR
| | | | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University , Hong Kong SAR
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23
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Audrit H, Beauchamp MH, Tinawi S, Laguë-Beauvais M, de Guise E. Development and description of SAAM intervention: A brief, multidimensional and psycho-educational intervention for adults with mild traumatic brain injury. Ann Phys Rehabil Med 2020; 64:101424. [PMID: 32771586 DOI: 10.1016/j.rehab.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is associated with persistent post-concussive symptoms (PCSs) in approximately 15% of cases. These symptoms can be somatic (e.g., headache), cognitive (e.g., forgetfulness, poor attention and concentration capacities), emotional (e.g., anxiety, depression, irritability) and/or sleep-arousal complaints (e.g., fatigue, sleep problems). Although practice guidelines recommend early intervention to prevent and treat PCS, we still lack an effective, standardized, integrative, post-acute intervention based on a sound and validated theoretical model. OBJECTIVES The purpose of this article is to present the development and theoretical background underpinning a novel intervention for patients with PCSs in the post-acute phase after mTBI (1-3 months post-injury). PROCEDURE With a biopsychosocial approach (Hou et al., 2012) and best practice recommendations, we developed a novel multidimensional intervention targeting factors that perpetuate PCSs and that can be changed with the intervention. This individual-session intervention provides practical tools for managing PCSs and is designed to provide psycho-education and reassurance, reinforce individual objectives and promote a return to activities. Each session targets one category of PCSs: Sleep/fatigue, Attention, Anxiety/depressed mood, Memory/Organization (SAAM intervention). The rationale underlying the choices of format and content for the intervention is discussed, as are the associated strengths, limitations, opportunities and challenges. CONCLUSION This article could support researchers and clinicians to develop, replicate and/or implement interventions addressing current best practices in mTBI management.
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Affiliation(s)
- Hélène Audrit
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - Simon Tinawi
- McGill University Health Centre, Traumatic Brain Injury program, Montreal, Quebec, Canada
| | - Maude Laguë-Beauvais
- McGill University Health Centre, Traumatic Brain Injury program, Montreal, Quebec, Canada
| | - Elaine de Guise
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada; Research Institute of McGill University Health Centre, Montreal, Quebec, Canada.
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24
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Ramanathan-Elion DM, Baydoun HA, Johnstone B. Psychological predictors of functional outcomes in service members with traumatic brain injury. Brain Inj 2020; 34:1183-1192. [PMID: 32683899 DOI: 10.1080/02699052.2020.1793387] [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: 10/23/2022]
Abstract
PRIMARY OBJECTIVE Research is increasingly demonstrating the significant impact that non-medical factors can have on outcomes of service members (SMs) with mild traumatic brain injury (mTBI). Thus, the current study examined which demographic, TBI-related factors, and psychological variables are most predictive of functional outcomes. RESEARCH DESIGN Retrospective database analysis from medical chart review. METHODS AND PROCEDURES One hundred forty-one patients who received rehabilitation services at an outpatient TBI military treatment facility between 2013 and 2018. Data collected included demographic variables, time since injury, neuropsychological measures, psychological diagnoses, Personality Assessment Inventory (PAI) scores, and Walter Reed Functional Impairment Scale (FIS). Hierarchical linear regression models were used to predict functional outcomes (measured by FIS total, work, social functioning scales). MAIN OUTCOMES AND RESULTS Results indicated that comorbid PTSD diagnosis and PAI Negative Impression Management (NIM) score were predictive of total functional, work, and social outcomes, over and above demographic and TBI-related factors. CONCLUSIONS Current findings confirmed the importance of evaluating and treating psychological factors, as well as exploring one's responding style (NIM), when managing chronic mTBI in SMs. Given ongoing findings of psychological underpinnings to mTBI outcome, there is further need to focus on early interventions to optimize psychological and functional outcomes for SMs.
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Affiliation(s)
- Deepa M Ramanathan-Elion
- Department of Behavioral Health, Fort Belvoir Intrepid Spirit Center , Fort Belvoir, Virginia, USA
| | - Hind A Baydoun
- Department of Research Programs, Fort Belvoir Community Hospital , Fort Belvoir, Virginia, USA
| | - Brick Johnstone
- Defense and Veterans Brain Injury Center, Fort Belvoir Intrepid Spirit Center , Fort Belvoir, Virginia, USA.,Virginia Crawford Research Institute, Shepherd Center , Atlanta, Georgia, USA
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25
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Arbabi M, Sheldon RJG, Bahadoran P, Smith JG, Poole N, Agrawal N. Treatment outcomes in mild traumatic brain injury: a systematic review of randomized controlled trials. Brain Inj 2020; 34:1139-1149. [PMID: 32715768 DOI: 10.1080/02699052.2020.1797168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M Arbabi
- Brain & Spinal Cord Injury Research Centre, Tehran University of Medical Sciences, Tehran, Iran
- Psychosomatic Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - RJG Sheldon
- Sussex Partnership NHS Foundation Trust, Worthing, UK
- Department of Neuropsychiatry, St George’s Hospital, London, UK
- South West London and St George’s Mental Health NHS Trust, London, UK
| | - P Bahadoran
- Department of Neuropsychiatry, St George’s Hospital, London, UK
- South West London and St George’s Mental Health NHS Trust, London, UK
| | - JG Smith
- Population Health Research Institute, St George’s, University of London, London, UK
| | - N Poole
- Department of Neuropsychiatry, St George’s Hospital, London, UK
- South West London and St George’s Mental Health NHS Trust, London, UK
| | - N Agrawal
- Department of Neuropsychiatry, St George’s Hospital, London, UK
- South West London and St George’s Mental Health NHS Trust, London, UK
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26
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Abdul Rahman N'I, Nurumal MS, Awang MS, Mohd Shah ANS. Emergency department discharge instruction for mild traumatic brain injury: Evaluation on readability, understandability, actionability and content. Australas Emerg Care 2020; 23:240-246. [PMID: 32713770 DOI: 10.1016/j.auec.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/31/2020] [Accepted: 06/20/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Emergency departments (EDs) routinely provide discharge instructions due to a large number of patients with mild traumatic brain injury (mTBI) being discharged home directly from ED. This study aims to evaluate the quality of available mTBI discharge instructions provided by EDs of Malaysia government hospitals. METHODS All 132 EDs were requested for a copy of written discharge instruction given to the patients. The mTBI discharge instructions were evaluated using the Patient Education Materials Assessment-Printable Tool (PEMAT-P) for understandability and actionability. Readability was measured using an online readability tool of Malay text. The content was compared against the discharge instructions recommended by established guidelines. RESULTS 49 articles were eligible for the study. 26 of the articles met the criteria of understandability, and 3 met the criteria for actionability. The average readability level met the ability of average adult. Most of the discharge instructions focused on emergency symptoms, and none contained post-concussion features. CONCLUSION Majority of the discharge instructions provided were appropriate for average people to read but difficult to understand and act upon. Important information was neglected in most discharge instructions. Thus, revision and future development of mTBI discharge instruction should consider health literacy demand and cognitive ability to process such information.
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Affiliation(s)
- Nurul 'Inayati Abdul Rahman
- Department of Critical Care Nursing, Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia.
| | - Mohd Said Nurumal
- Department of Critical Care Nursing, Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Mohamed Saufi Awang
- Neurosurgery Unit, Department of Surgery, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Aida Nur Sharini Mohd Shah
- Department of Internal Medicine, Kulliyyah (Faculty) of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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27
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van Gils A, Stone J, Welch K, Davidson LR, Kerslake D, Caesar D, McWhirter L, Carson A. Management of mild traumatic brain injury. Pract Neurol 2020; 20:213-221. [DOI: 10.1136/practneurol-2018-002087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2020] [Indexed: 11/04/2022]
Abstract
Mild traumatic brain injury (TBI) is common and associated with a range of diffuse, non-specific symptoms including headache, nausea, dizziness, fatigue, hypersomnolence, attentional difficulties, photosensitivity and phonosensitivity, irritability and depersonalisation. Although these symptoms usually resolve within 3 months, 5%–15% of patients are left with chronic symptoms. We argue that simply labelling such symptoms as ‘postconcussional’ is of little benefit to patients. Instead, we suggest that detailed assessment, including investigation, both of the severity of the ‘mild’ injury and of the individual symptom syndromes, should be used to tailor a rehabilitative approach to symptoms. To complement such an approach, we have developed a self-help website for patients with mild TBI, based on neurorehabilitative and cognitive behavioural therapy principles, offering information, tips and tools to guide recovery: www.headinjurysymptoms.org.
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Psychological Symptoms and Rates of Performance Validity Improve Following Trauma-Focused Treatment in Veterans with PTSD and History of Mild-to-Moderate TBI. J Int Neuropsychol Soc 2020; 26:108-118. [PMID: 31658923 DOI: 10.1017/s1355617719000997] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance. METHOD Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass). RESULTS Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition. CONCLUSION Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
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29
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Shura RD, Epstein EL, Armistead-Jehle P, Cooper DB, Eapen BC. Assessment and Treatment of Concussion in Service Members and Veterans. Concussion 2020. [DOI: 10.1016/b978-0-323-65384-8.00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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30
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Thastum MM, Rask CU, Næss-Schmidt ET, Tuborgh A, Jensen JS, Svendsen SW, Nielsen JF, Schröder A. Novel interdisciplinary intervention, GAIN, vs. enhanced usual care to reduce high levels of post-concussion symptoms in adolescents and young adults 2-6 months post-injury: A randomised trial. EClinicalMedicine 2019; 17:100214. [PMID: 31891145 PMCID: PMC6933237 DOI: 10.1016/j.eclinm.2019.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/11/2019] [Accepted: 11/12/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Evidence for effective interventions to prevent long-term sequelae after concussion is sparse. This study aimed to test the efficacy of Get going After concussIoN (GAIN), an interdisciplinary, individually-tailored intervention of 8 weeks duration based on gradual return to activities and principles from cognitive behavioural therapy. METHODS We conducted an open-label, parallel-group randomised trial in a hospital setting in Central Denmark Region. Participants were 15-30-year-old patients with high levels of post-concussion symptoms (PCS) 2-6 months post-concussion (i.e., a score ≥20 on the Rivermead Post-concussion Symptoms Questionnaire (RPQ)). They were randomly assigned (1:1) to either enhanced usual care (EUC) or GAIN+EUC. Masking of participants and therapists was not possible. The primary outcome was change in RPQ-score from baseline to 3-month FU. All analyses were done on an intention-to-treat basis using linear mixed-effects models. This trial is registered with ClinicalTrials.gov, number NCT02337101. FINDINGS Between March 1, 2015, and September 1, 2017, we included 112 patients. Patients allocated to GAIN+EUC (n=57) reported a significantly larger reduction of PCS than patients allocated to EUC (n=55) with a mean adjusted difference in improvement of 7·6 points (95% confidence interval (CI) 2·0-13·1, p=0·008), Cohen's d=0·5 (95% CI 0·1-0·9). Number needed to treat for prevention of one additional patient with RPQ ≥20 at 3-month FU was 3·6 (95% CI 2·2-11·3). No adverse events were observed. INTERPRETATION Compared with EUC, GAIN+EUC was associated with a larger reduction of post-concussion symptoms at 3-month FU. FUNDING Central Denmark Region and the foundation "Public Health in Central Denmark Region - a collaboration between municipalities and the region".
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Affiliation(s)
- Mille Moeller Thastum
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark
- Corresponding author.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark
| | | | - Astrid Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark
| | - Jens Sondergaard Jensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark
| | - Susanne Wulff Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus, Denmark
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31
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Ali JI, Mahoney P, Dance D, Silverberg ND. Outcomes of a brief coping skills group intervention for adults with severe postconcussion symptoms. Concussion 2019; 4:CNC67. [PMID: 31827884 PMCID: PMC6902311 DOI: 10.2217/cnc-2019-0011] [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: 11/21/2022] Open
Abstract
Aim: The aim of this study was to evaluate a brief psychologically informed coping skills group intervention for adults with severe prolonged symptoms following mild traumatic brain injury (mTBI). Methodology & results: Patients attended an education session about mTBI; 22 patients completed an additional coping skills group intervention, 16 declined/stopped the intervention early and 19 were not offered the intervention. At follow-up, patients who completed the intervention reported a similar degree of symptom improvement and disability as those who did not complete the intervention. The majority of patients who completed the intervention were satisfied with it and perceived it to be credible. Conclusion: The coping skills intervention was not associated with measurable clinical benefit. Recommendations for improving psychological interventions for mTBI are discussed.
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Affiliation(s)
- Jordan I Ali
- Department of Psychology, University of Victoria, Victoria, BC, V8W 2Y2, Canada
| | - Patricia Mahoney
- Acquired Brain Injury Program, GF Strong Rehabilitation Centre, Vancouver, BC, V5Z 2G9, Canada
| | - Derry Dance
- Acquired Brain Injury Program, GF Strong Rehabilitation Centre, Vancouver, BC, V5Z 2G9, Canada.,Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, V5Z 2G9, Canada
| | - Noah D Silverberg
- Acquired Brain Injury Program, GF Strong Rehabilitation Centre, Vancouver, BC, V5Z 2G9, Canada.,Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, V5Z 2G9, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, V5Z 2G9, Canada
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32
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Taylor JE, Seebeck RF. Preinjury Psychological Factors and Case Formulation in Mild Traumatic Brain Injury Rehabilitation: A Case Report. REHABILITATION COUNSELING BULLETIN 2019. [DOI: 10.1177/0034355219878500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mild traumatic brain injury (TBI) accounts for the majority of TBIs. Most cases recover within 3 months and usual medical advice covers physical and cognitive rest, activity and fatigue management, and education. However, in some cases, symptoms can persist and there may be ongoing postconcussion difficulties. It is well established that pre- and postinjury psychological factors can contribute to cases of persistent postconcussion symptoms. However, there are few illustrative case examples in the published literature on mild TBI. This case example demonstrates the pivotal role that preinjury psychological factors can play in recovery from mild TBI, using an example of a 35-year-old woman with persistent mild TBI symptoms who had a limited response to previous brief treatment through a Concussion Clinic. Through the process of assessment and development of a psychological case formulation, preinjury psychological factors that had been barriers to recovery and prior rehabilitation efforts were identified. Rehabilitation counselors are equipped to (1) identify and address such barriers, (2) communicate this information to other rehabilitation professionals in the treatment team to facilitate a shared understanding of how factors might affect the client’s functioning and (3) contribute to team case formulation.
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33
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Hamzah N, Narayanan V, Ramli N, Mustapha NA, Mohammad Tahir NA, Tan LK, Danaee M, Muhamad NA, Drummond A, das Nair R, Goh SY, Mazlan M. Randomised controlled clinical trial of a structured cognitive rehabilitation in patients with attention deficit following mild traumatic brain injury: study protocol. BMJ Open 2019; 9:e028711. [PMID: 31537559 PMCID: PMC6756424 DOI: 10.1136/bmjopen-2018-028711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To measure the clinical, structural and functional changes of an individualised structured cognitive rehabilitation in mild traumatic brain injury (mTBI) population. SETTING A single centre study, Malaysia. PARTICIPANTS Adults aged between 18 and 60 years with mTBI as a result of road traffic accident, with no previous history of head trauma, minimum of 9 years education and abnormal cognition at 3 months will be included. The exclusion criteria include pre-existing chronic illness or neurological/psychiatric condition, long-term medication that affects cognitive/psychological status, clinical evidence of substance intoxication at the time of injury and major polytrauma. Based on multiple estimated calculations, the minimum intended sample size is 50 participants (Cohen's d effect size=0.35; alpha level of 0.05; 85% power to detect statistical significance; 40% attrition rate). INTERVENTIONS Intervention group will receive individualised structured cognitive rehabilitation. Control group will receive the best patient-centred care for attention disorders. Therapy frequency for both groups will be 1 hour per week for 12 weeks. OUTCOME MEASURES Primary: Neuropsychological Assessment Battery-Screening Module (S-NAB) scores. Secondary: Diffusion Tensor Imaging (DTI) parameters and Goal Attainment Scaling score (GAS). RESULTS Results will include descriptive statistics of population demographics, CogniPlus cognitive program and metacognitive strategies. The effect of intervention will be the effect size of S-NAB scores and mean GAS T scores. DTI parameters will be compared between groups via repeated measure analysis. Correlation analysis of outcome measures will be calculated using Pearson's correlation coefficient. CONCLUSION This is a complex clinical intervention with multiple outcome measures to provide a comprehensive evidence-based treatment model. ETHICS AND DISSEMINATION The study protocol was approved by the Medical Research Ethics Committee UMMC (MREC ID NO: 2016928-4293). The findings of the trial will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER NCT03237676.
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Affiliation(s)
- Norhamizan Hamzah
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vairavan Narayanan
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Ramli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Atikah Mustapha
- Department of Rehabilitation Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Asiah Muhamad
- Institute for Public Health, National Institutes of Health, Ministry of Health, Setia Alam, Malaysia
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Roshan das Nair
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Institute of Mental Health, Nottinghamshire Healthcare Trust, Nottingham, United Kingdom
| | - Sing Yau Goh
- Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Sungai Long Campus, Malaysia
| | - Mazlina Mazlan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Auclair-Pilote J, Lalande D, Tinawi S, Feyz M, de Guise E. Satisfaction of basic psychological needs following a mild traumatic brain injury and relationships with post-concussion symptoms, anxiety, and depression. Disabil Rehabil 2019; 43:507-515. [PMID: 31230472 DOI: 10.1080/09638288.2019.1630858] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Self-determination theory proposes that the satisfaction of basic psychological needs (competence, autonomy, and relatedness) is essential to psychological well-being. This study aims to explore the acute impact of a mild traumatic brain injury on the perception of need satisfaction as well as to better understand which variables among post-concussion symptoms and mood are associated with the satisfaction of these psychological needs. MATERIAL AND METHODS A total of 179 adults with mild traumatic brain injury were included. The Basic Psychological Needs Satisfaction Scale (BPNS) was completed retrospectively to assess need satisfaction pre-injury and after the injury to assess need satisfaction post-injury. The Rivermead Post Concussion Symptoms Questionnaire as well as the Hospital Anxiety and Depression Scale were also completed post injury. RESULTS A significant difference between the perception of need satisfaction pre- and post- was found on the total BPNS score, with lower scores on the post-injury evaluation (less satisfaction). Moreover, higher levels of depression and anxiety were associated with less satisfaction. CONCLUSIONS These results suggest that sustaining a mild traumatic brain injury may have a negative impact on the satisfaction of competence, autonomy, and relatedness needs. To conclude, it is recommended that these concepts be included in psychological intervention programs following mild traumatic brain injury.Implications for rehabilitationA significant decrease in psychological need satisfaction is highlighted following mild traumatic brain injury.It is recommended that the needs of autonomy, competence, and relatedness in intervention programs following mild traumatic brain injury needs to be addressed.The more mild traumatic brain injury patients are anxious and depressed the more likely it is that they will present a diminished satisfaction of needs, expressed by a lower level of perception of their autonomy, competence, and relatedness. Thus, integrative intervention for anxiety as well as depression following mild traumatic brain injury is also recommended.
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Affiliation(s)
- Jennyfer Auclair-Pilote
- Department of Psychology, Université de Montréal, Montréal, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Canada
| | - Daniel Lalande
- Department of Psychology, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Simon Tinawi
- Traumatic Brain Injury Program, McGill University Health Center, Montréal, Canada
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Center, Montréal, Canada
| | - Elaine de Guise
- Department of Psychology, Université de Montréal, Montréal, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Canada.,Research Institute-McGill University Health Center, Montréal, Canada
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Psychological Intervention in Traumatic Brain Injury Patients. Behav Neurol 2019; 2019:6937832. [PMID: 31191738 PMCID: PMC6525953 DOI: 10.1155/2019/6937832] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/20/2018] [Accepted: 03/19/2019] [Indexed: 01/25/2023] Open
Abstract
Objective To provide a brief and comprehensive summary of recent research regarding psychological interventions for patients surviving a traumatic brain injury. Methods A bibliographical search was performed in PubMed, Cochrane Library, PsycNET, Scopus, ResearchGate, and Google Scholar online databases. Analysis included distribution by year of publication, age stage of participants (paediatric, adult), location of the research team, study design, type of intervention, and main outcome variables. Results The initial search eliciting 1541 citations was reduced to 62 relevant papers. Most publications had adult samples (88.7%). The United States outstands as the country with more research (58.1%); Latin America countries provided no results. Cognitive behavioural therapy (CBT) was the most widely used approach for treatment of (sub)clinical mental disturbances (41.9%). Neuropsychological interventions were scarce (4.8%). Outcome measures included psychiatric disorders (e.g., posttraumatic stress disorder (PTSD), depression, and anxiety) (37.1%), postconcussive symptoms (16.1%), cognitive and functional deficits (48.1%), and social and psychological dimensions (62.9%). Conclusions CBT outstands as the preferred therapeutic approach for treating behavioural and emotional disturbances. Also, other related therapies such as dialectical behaviour, mindfulness, and acceptance and commitment therapies have been proposed, and probably in the years to come, more literature regarding their effectiveness will be available. On the other hand, evidence showed that interventions from the field of neuropsychology are minimal if compared with its contribution to assessment. Future research should be aimed at performing studies on more diverse populations (e.g., nonmilitary communities and paediatric and Latin American populations) and at controlling designs to examine the therapeutic efficacy of psychotherapeutic and neurocognitive rehabilitation interventions and compare amelioration by injury severity, age of patients, and clinical profile, in the hopes of creating better guidelines for practitioners.
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Sullivan KA, Kaye SA, Blaine H, Edmed SL, Meares S, Rossa K, Haden C. Psychological approaches for the management of persistent postconcussion symptoms after mild traumatic brain injury: a systematic review. Disabil Rehabil 2019; 42:2243-2251. [DOI: 10.1080/09638288.2018.1558292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karen A. Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Sherrie-Anne Kaye
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Hannah Blaine
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Shannon L. Edmed
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Susanne Meares
- Department of Psychology, Macquarie University, Sydney, Australia
- Brain Injury Rehabilitation Services, Westmead Hospital, Sydney, Australia
| | - Kalina Rossa
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Catherine Haden
- Library, Queensland University of Technology, Brisbane, Australia
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Snell DL, Martin R, Surgenor LJ, Siegert RJ, Hay-Smith EJC, Melzer TR, Anderson TJ, Hooper GJ. Wrestling with uncertainty after mild traumatic brain injury: a mixed methods study. Disabil Rehabil 2019; 42:1942-1953. [PMID: 30676112 DOI: 10.1080/09638288.2018.1542461] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Our objective was to explore the intersection between mild traumatic brain injury (MTBI) recovery experiences and injury understandings, using both quantitative and qualitative methods.Materials and Methods: The quantitative component was a descriptive case-control study comparing participants (n = 76) who had recovered or not recovered after an MTBI, across demographic and psychological variables. A subset of participants (n = 10) participated in a semi-structured interview to explore experiences of recovery in more detail. We followed threads across the datasets to integrate findings from component methods.Results: The quantitative analyses revealed differences between the two groups in terms of injury recovery understandings and expectations. The qualitative analyses suggested that achieving consistency across information sources was important. By tracing threads back and forth between the component datasets, we identified a super-ordinate meta-theme that captured participants' experiences of wrestling with uncertainty about their recovery and the impacts in terms of heightened anxiety, confusion, and feelings of invalidation.Conclusion: The effectiveness of psychoeducation and reassurance after MTBI may be optimized when content is tailored to the individual. Clinicians are urged to attend both to the subjective interpretations patients make of information gained from formal and informal, internal and external sources, and where information across these sources conflicts and creates uncertainty.Implications for rehabilitationEffectiveness of psychoeducation and reassurance after injury may be optimized when content is tailored to the individual rather than being generic.Effectiveness of such interventions may also be optimized by understanding the subjective interpretations individuals make of injury knowledge gleaned from formal and informal, internal and external sources.Conflicting information from such multiple sources may create uncertainty with associated increased distress as an individual negotiates their recovery from injury. Attending to this uncertainty may be a helpful target for treatment.
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Affiliation(s)
- Deborah L Snell
- Concussion Clinic, Burwood Hospital, Christchurch, New Zealand.,Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Rachelle Martin
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Lois J Surgenor
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Siegert
- Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand
| | - E Jean C Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Tracy R Melzer
- Department of Medicine, University of Otago, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand.,Brain Research New Zealand Centre of Research Excellence, New Zealand
| | - Tim J Anderson
- Department of Medicine, University of Otago, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand.,Brain Research New Zealand Centre of Research Excellence, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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Rytter HM, Westenbaek K, Henriksen H, Christiansen P, Humle F. Specialized interdisciplinary rehabilitation reduces persistent post-concussive symptoms: a randomized clinical trial. Brain Inj 2018; 33:266-281. [DOI: 10.1080/02699052.2018.1552022] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hana Mala Rytter
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | | | | | - Frank Humle
- Centre for Rehabilitation of Brain Injury, Copenhagen, Denmark
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Thastum MM, Rask CU, Naess-Schmidt ET, Jensen JS, Frederiksen OV, Tuborgh A, Svendsen SW, Nielsen JF, Schröder A. Design of an early intervention for persistent post-concussion symptoms in adolescents and young adults: A feasibility study. NeuroRehabilitation 2018; 43:155-167. [PMID: 30040756 DOI: 10.3233/nre-172391] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND About 5-15 % of patients with concussion experience persistent post-concussion symptoms (PCS) longer than 3 months post-injury. OBJECTIVE To explore the feasibility of a new intervention for young patients with persistent PCS and long-term changes after intervention. METHODS Thirty-two consecutive patients (15-30 years) with persistent PCS 2-4 months post-injury were recruited from a cohort study or referred to a non-randomized feasibility study of an individually tailored, 8-week, multidisciplinary intervention. Assessment was performed at baseline, end of intervention (EOI), and at 3- and 12-month follow-up (FU). Main measures were The Experience of Service Questionnaire (ESQ), Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and The Quality of Life after Brain Injury - Overall Scale (QOLIBRI-OS). RESULTS Twenty-three (72%) patients completed the intervention. The ESQ demonstrated high patient satisfaction. There was a decrease of PCS and an increase in quality of life from baseline to EOI: RPQ score -8.9 points, 95% CI 4.5 to 13.3, p < 0.001; QOLIBRI-OS score +10.5 points, 95% CI 2.5 to 18.5, p = 0.010. Improvement was maintained at 3- and 12-month FU. CONCLUSION The new early intervention is feasible and may prevent chronification of PCS. An RCT is currently performed to evaluate the effect of the intervention.
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Affiliation(s)
- Mille Moeller Thastum
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark.,Child and Adolescent Psychiatric Center, Risskov, Aarhus University Hospital, Denmark
| | | | | | - Oana-Veronica Frederiksen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Astrid Tuborgh
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark.,Child and Adolescent Psychiatric Center, Risskov, Aarhus University Hospital, Denmark
| | - Susanne Wulff Svendsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Joergen Feldbaek Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Andreas Schröder
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
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Kreutzer JS, Marwitz JH, Sima AP, Mills A, Hsu NH, Lukow HR. Efficacy of the resilience and adjustment intervention after traumatic brain injury: a randomized controlled trial. Brain Inj 2018; 32:963-971. [DOI: 10.1080/02699052.2018.1468577] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Jeffrey S. Kreutzer
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer H. Marwitz
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam P. Sima
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Ana Mills
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Nancy H. Hsu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Herman R. Lukow
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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Symptom Reporting and Management of Chronic Post-Concussive Symptoms in Military Service Members and Veterans. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0173-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Snell DL, Martin R, Macleod A, Surgenor LJ, Siegert RJ, Hay-Smith EJC, Melzer T, Hooper GJ, Anderson T. Untangling chronic pain and post-concussion symptoms: the significance of depression. Brain Inj 2018; 32:583-592. [DOI: 10.1080/02699052.2018.1432894] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Deborah L. Snell
- Concussion Clinic, Burwood Hospital, Christchurch, New Zealand
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Rachelle Martin
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, Wellington, New Zealand
| | - A.D. Macleod
- Concussion Clinic, Burwood Hospital, Christchurch, New Zealand
| | - Lois J. Surgenor
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Richard J. Siegert
- Faculty of Health and Environmental Studies, AUT University, Auckland, New Zealand
| | - E. Jean, C. Hay-Smith
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, Wellington, New Zealand
| | - Tracy Melzer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- Brain Research New Zealand, Centre of Research Excellence, New Zealand
| | - Gary J. Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Tim Anderson
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
- New Zealand Brain Research Institute, Christchurch, New Zealand
- Brain Research New Zealand, Centre of Research Excellence, New Zealand
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Theadom A, Starkey N, Barker-Collo S, Jones K, Ameratunga S, Feigin V. Population-based cohort study of the impacts of mild traumatic brain injury in adults four years post-injury. PLoS One 2018; 13:e0191655. [PMID: 29385179 PMCID: PMC5791998 DOI: 10.1371/journal.pone.0191655] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/09/2018] [Indexed: 11/22/2022] Open
Abstract
There is increasing evidence that some people can experience persistent symptoms for up to a year following mild TBI. However, few longitudinal studies of mild TBI exist and the longer-term impact remains unclear. The purpose of this study is to determine if there are long-term effects of mild traumatic brain injury (TBI) four-years later. Adults (aged ≥16 years) identified as part of a TBI incidence study who experienced a mild-TBI four-years ago (N = 232) were compared to age-sex matched controls (N = 232). Sociodemographic variables, prior TBI and symptoms were assessed at the time of injury. Four years post-injury participants completed the Rivermead Post-Concussion Symptom Questionnaire, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index and the Participation Assessment with Recombined Tools. Analysis of covariance was used to compare differences between TBI cases four years post-injury and controls, controlling for prior TBI and depression. A multiple regression model was used to identify the predictors of increased symptoms and reduced participation. The mild-TBI sample experienced significantly increased self-reported cognitive symptoms (F = 19.90, p = <0.01) four years post-injury than controls. There were no differences between the groups for somatic (F = 0.02, p = 0.89) or emotional symptoms (F = 0.31, p = 0.58). Additionally, the mild-TBI group reported significantly poorer community participation across all three domains: productivity (F = 199.07, p = <0.00), social relations (F = 13.93, p = <0.00) and getting out and about (F = 364.69, p = <0.00) compared to controls. A regression model accounting for 41% of the variance in cognitive symptoms in TBI cases revealed a history of TBI, receiving acute medical attention and baseline cognitive symptoms, sleep quality, anxiety and depression were predictive of outcome. The results indicate that whilst somatic and emotional symptoms resolve over time, cognitive symptoms can become persistent and that mild TBI can impact longer-term community participation. Early intervention is needed to reduce the longer-term impact of cognitive symptoms and facilitate participation.
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Affiliation(s)
- Alice Theadom
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
- * E-mail:
| | - Nicola Starkey
- Department of Psychology, University of Waikato, Knighton Road, Waikato, New Zealand
| | | | - Kelly Jones
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Valery Feigin
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
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Næss-Schmidt ET, Blicher JU, Tietze A, Rask CU, Svendsen SW, Schröder A, Thastum MM, Tuborgh AH, Frederiksen OV, Østergaard L, Eskildsen SF, Hansen B, Jespersen S, Nielsen JF. Diffusion MRI findings in patients with extensive and minimal post-concussion symptoms after mTBI and healthy controls: a cross sectional study. Brain Inj 2017; 32:91-98. [PMID: 29095055 DOI: 10.1080/02699052.2017.1377352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PRIMARY OBJECTIVES We hypothesized that the microstructure of the corpus callosum, thalamus and hippocampus, as measured with diffusion and Mean of the Kurtosis Tensor (MKT) MRI, differs between healthy subjects and patients with extensive and minimal post-concussion symptoms (PCS) and that MKT measures correlate with PCS severity and self-reported cognitive symptoms. RESEARCH DESIGN A cross-sectional study comparing patients with extensive PCS and patients with minimal PCS 2-5 months after mild traumatic brain injury (mTBI) with each other and with an external healthy control group. METHODS AND PROCEDURES Diffusion MRI was obtained in 25 patients with extensive PCS and in 25 patients with minimal PCS as measured by the Rivermead Post-concussion Symptoms Questionnaire. The patients were matched on age, sex and time since accident. Data from an external healthy control group (n = 27) was included. MAIN OUTCOME AND RESULTS There was no difference in MKT between the two groups with mTBI and no correlation between MKT and PCS. There was no difference between the three groups in other diffusion measures. CONCLUSIONS Our results did not point to microstructural changes in the corpus callosum, thalamus and hippocampus in relation to PCS after mTBI.
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Affiliation(s)
| | - Jakob Udby Blicher
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Anna Tietze
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.,c Dept of Neuroradiology , Aarhus University Hospital , Aarhus , Denmark
| | - Charlotte Ulrikka Rask
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark.,e Regional Centre for Child and Adolescent Psychiatry, Risskov , Aarhus University Hospital , Aarhus , Denmark
| | - Susanne Wulff Svendsen
- a Dept of Clinical Medicine , Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Hammel , Denmark
| | - Andreas Schröder
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
| | - Mille Møller Thastum
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
| | - Astrid Høeg Tuborgh
- d Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark
| | - Oana-Veronica Frederiksen
- a Dept of Clinical Medicine , Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Hammel , Denmark
| | - Leif Østergaard
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.,c Dept of Neuroradiology , Aarhus University Hospital , Aarhus , Denmark
| | - Simon Fristed Eskildsen
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Brian Hansen
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Sune Jespersen
- b Center of Functionally Integrative Neuroscience, Institute of Clinical Medicine , Aarhus University , Aarhus , Denmark.,f Dept of Physics and Astronomy , Aarhus University , Aarhus , Denmark
| | - Jørgen Feldbæk Nielsen
- a Dept of Clinical Medicine , Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University , Hammel , Denmark
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Devonish J, Homish D, Vest B, Daws R, Hoopsick R, Homish G. The impact of military service and traumatic brain injury on the substance use norms of Army Reserve and National Guard Soldiers and their spouses. Addict Behav 2017; 72:51-56. [PMID: 28388492 DOI: 10.1016/j.addbeh.2017.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) and substance use are highly prevalent conditions among military populations. There is a significant body of evidence that suggests greater approval of substance use (i.e., norms) is related to increased substance use. The objective of this work is to understand the impact of TBI and military service on substance use norms of soldiers and their partners. Data are from the baseline assessment of Operation: SAFETY, an ongoing, longitudinal study of US Army Reserve/National Guard (USAR/NG) soldiers and their partners. METHODS Multiple regression models examined associations between alcohol, tobacco, illicit drug use, and non-medical use of prescription drug (NMUPD) norms within and across partners based on current military status (CMS) and TBI. RESULTS Male USAR/NG soldiers disapproved of NMUPD, illicit drug use and tobacco use. There was no relation between military status and alcohol use. Among females, there was no relation between CMS and norms. The NMUPD norms of wives were more likely to be approving if their husbands reported TBI symptoms and had separated from the military. Husbands of soldiers who separated from the military with TBI had greater approval of the use of tobacco, NMUPD, and illicit drugs. CONCLUSION Overall, there is evidence to suggest that, while generally disapproving of substance use, soldiers and partners become more accepting of use if they also experience TBI and separate from the military. Future research should examine the longitudinal influence of TBI on substance use norms and subsequent changes in substance use over time.
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Prince C, Bruhns ME. Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology. Brain Sci 2017; 7:brainsci7080105. [PMID: 28817065 PMCID: PMC5575625 DOI: 10.3390/brainsci7080105] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 11/04/2022] Open
Abstract
Awareness of mild traumatic brain injury (mTBI) and persisting post-concussive syndrome (PCS) has increased substantially in the past few decades, with a corresponding increase in research on diagnosis, management, and treatment of patients with mTBI. The purpose of this article is to provide a narrative review of the current literature on behavioral assessment and management of patients presenting with mTBI/PCS, and to detail the potential role of neuropsychologists and rehabilitation psychologists in interdisciplinary care for this population during the acute, subacute, and chronic phases of recovery.
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Affiliation(s)
- Carolyn Prince
- JFK Johnson Rehabilitation Institute, Center for Brain Injuries, Edison, NJ 08820, USA.
| | - Maya E Bruhns
- Alta Bates Summit Medical Center, Oakland, CA 94609, USA.
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Moore P, Mawdsley L, Jackson CF, Atherton MJ. Psychological interventions for persisting postconcussion symptoms following traumatic brain injury. Cochrane Database Syst Rev 2017; 2017:CD012755. [PMCID: PMC6483315 DOI: 10.1002/14651858.cd012755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of psychological interventions for people with persisting postconcussion symptoms.
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Affiliation(s)
- Perry Moore
- The Walton Centre NHS Foundation TrustLower LaneFazakerleyLiverpoolUKL9 7LJ
| | - Lucinda Mawdsley
- The Walton Centre NHS Foundation TrustDepartment of NeuropsychologyLower LaneFazakerleyLiverpoolUKL9 7LJ
| | - Cerian F Jackson
- Institute of Translational Medicine, University of LiverpoolDepartment of Molecular and Clinical PharmacologyClinical Sciences Centre for Research and Education, Lower LaneFazakerleyLiverpoolUKL9 7LJ
| | - Michael J Atherton
- The Walton Centre NHS Foundation TrustDepartment of NeuropsychologyLower LaneFazakerleyLiverpoolUKL9 7LJ
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Yang CC, Chiu HC, Xiao SH, Tsai YH, Lee YC, Ku YT, Lin RS, Lin WC, Huang SJ. Iatrogenic Effect? Cautions when Utilizing an Early Health Education for Post-concussion Symptoms. Arch Clin Neuropsychol 2017; 33:131-142. [DOI: 10.1093/arclin/acx060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 06/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chi-Cheng Yang
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Hsiao-Chun Chiu
- Pediatric Psychiatry, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sheng-Huang Xiao
- Department of Psychology, National Chengchi University, Taipei, Taiwan
- Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | - Yi-Hsin Tsai
- Department of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Chien Lee
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Yi-Ting Ku
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Rong-Syuan Lin
- Division of Clinical Psychology, Master of Behavioral Science, Department of Occupational Therapy, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wei-Chi Lin
- Division of Clinical Psychology, Master of Behavioral Science, Department of Occupational Therapy, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
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Cognitive Rehabilitation for Military Service Members With Mild Traumatic Brain Injury: A Randomized Clinical Trial. J Head Trauma Rehabil 2017; 32:E1-E15. [DOI: 10.1097/htr.0000000000000254] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schneider KJ, Leddy JJ, Guskiewicz KM, Seifert T, McCrea M, Silverberg ND, Feddermann-Demont N, Iverson GL, Hayden A, Makdissi M. Rest and treatment/rehabilitation following sport-related concussion: a systematic review. Br J Sports Med 2017; 51:930-934. [PMID: 28341726 DOI: 10.1136/bjsports-2016-097475] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2017] [Indexed: 12/19/2022]
Abstract
AIM OR OBJECTIVE The objective of this systematic review was to evaluate the evidence regarding rest and active treatment/rehabilitation following sport-related concussion (SRC). DESIGN Systematic review. DATA SOURCES MEDLINE (OVID), CINAHL (EbscoHost), PsycInfo (OVID), Cochrane Central Register of Controlled Trials (OVID), SPORTDiscus (EbscoHost), EMBASE (OVID) and Proquest DissertationsandTheses Global (Proquest) were searched systematically. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they met the following criteria: (1) original research; (2) reported SRC as the diagnosis; and (3) evaluated the effect of rest or active treatment/rehabilitation. Review articles were excluded. RESULTS Twenty-eight studies met the inclusion criteria (9 regarding the effects of rest and 19 evaluating active treatment). The methodological quality of the literature was limited; only five randomised controlled trials (RCTs) met the eligibility criteria. Those RCTs included rest, cervical and vestibular rehabilitation, subsymptom threshold aerobic exercise and multifaceted collaborative care. SUMMARY/CONCLUSIONS A brief period (24-48 hours) of cognitive and physical rest is appropriate for most patients. Following this, patients should be encouraged to gradually increase activity. The exact amount and duration of rest are not yet well defined and require further investigation. The data support interventions including cervical and vestibular rehabilitation and multifaceted collaborative care. Closely monitored subsymptom threshold, submaximal exercise may be of benefit. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2016:CRD42016039570.
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Affiliation(s)
| | - John J Leddy
- Department of Orthopaedics, SUNY Buffalo, Buffalo, New York, USA
| | - Kevin M Guskiewicz
- Sports Medicine Research laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tad Seifert
- Norton Healthcare, Louisville, Kentucky, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Noah D Silverberg
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nina Feddermann-Demont
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Schulthess Clinic, Zurich, Switzerland
| | - Grant L Iverson
- Physical Medicine and Rehabilitation, Harvard Medical School; and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA
| | - Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Michael Makdissi
- Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia.,Olympic Park Sports Medicine Centre, Melbourne, Australia
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