1
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Simard P, Turcotte S, Vallée C, Lamontagne ME. Implementation of a strengths-based approach in a traumatic brain injury community service; perspectives of community workers. BRAIN IMPAIR 2024; 25:IB23063. [PMID: 38566287 DOI: 10.1071/ib23063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
Background The strengths-based approach (SBA) was initially developed for people living with mental health issues but may represent a promising support option for community participation of people living with a traumatic brain injury (TBI). A community-based organisation working with people living with TBI is in the process of adapting this approach to implement it in their organisation. No studies explored an SBA implementation with this population. This study explores the implementation of key components of the SBA in a community-based organisation dedicated to people living with TBI. Methods A qualitative descriptive design using semi-structured interviews (n = 10) with community workers, before and during implementation, was used. Transcripts were analysed inductively and deductively. Deductive coding was informed by the SBA fidelity scale. Results Group supervision and mobilisation of personal strengths are key SBA components that were reported as being integrated within practice. These changes led to improved team communication and cohesiveness in and across services, more structured interventions, and greater engagement of clients. No changes were reported regarding the mobilisation of environmental strengths and the provision of individual supervision. Conclusion The implementation of the SBA had positive impacts on the community-based organisation. This suggests that it is valuable to implement an adaptation of the SBA for people living with TBI.
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Affiliation(s)
- Pascale Simard
- School of Rehabilitation, Université Laval, Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada
| | - Samuel Turcotte
- School of Rehabilitation, Université Laval, Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada
| | - Catherine Vallée
- School of Rehabilitation, Université Laval, VITAM Center for Sustainable Health Research, Québec, QC, Canada
| | - Marie-Eve Lamontagne
- School of Rehabilitation, Université Laval, Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC, Canada
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2
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Eliacin J, Fortney SK, Rattray NA, Kean J. Patients' and caregivers' perspectives on healthcare navigation in Central Indiana, USA after brain injury. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:988-997. [PMID: 33471969 DOI: 10.1111/hsc.13275] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Little research has documented the experiences of patients with traumatic brain injury (TBI) and their caregivers in navigating health systems for TBI care. In this qualitative study, we conducted semi-structured interviews with 62 participants (34 patients with moderate or severe TBI and 28 caregivers) from Central Indiana. Data were collected from January to September 2016 and analysed using a constructivist grounded theory approach. Participants discussed three significant challenges about navigating health services for TBI care: lack of support for care navigation, financial barriers, and communication barriers. Participants described how navigating outpatient healthcare services for TBI remains complex and emphasised the need for ongoing care navigation support throughout the care continuum. They detailed the long-term financial burden of TBI including high treatment costs, limited insurance coverage, and the emotional toll that financial stress has on their ability to navigate healthcare services for ongoing TBI-related needs. They also discussed how ineffective patient-provider communication and lack of reliable, timely and comprehensive health information about TBI limited their engagement in and navigation of TBI health services. Findings suggest that persons with TBI and their caregivers need ongoing support to manage the long-term impacts of TBI. Efforts to provide care coordination and navigation to patients with TBI and their families are urgently needed to facilitate greater access to care, effective healthcare navigation and improved health outcomes.
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Affiliation(s)
- Johanne Eliacin
- Richard L. Roudebush Department of Veterans Affairs Medical Center, Center for Health Information and Communication, Health Services Research and Development, Indianapolis, IN, USA
- Departments of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
- Regenstrief Institute, Inc. Indianapolis, IN, USA
- Act Center of Indiana, Indianapolis, IN, USA
| | - Sarah K Fortney
- Departments of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Nicholas A Rattray
- Richard L. Roudebush Department of Veterans Affairs Medical Center, Center for Health Information and Communication, Health Services Research and Development, Indianapolis, IN, USA
- Department of Anthropology, Indiana University Purdue University at Indianapolis, Indianapolis, IN, USA
| | - Jacob Kean
- Informatics, Decision-Enhancement and Analytic Sciences Center, Health Services Research and Development, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah School of Medicine, Salt Lake City, UT, USA
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3
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Goss AL, Creutzfeldt CJ. Prognostication, Ethical Issues, and Palliative Care in Disorders of Consciousness. Neurol Clin 2022; 40:59-75. [PMID: 34798975 PMCID: PMC8672806 DOI: 10.1016/j.ncl.2021.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Research advances in recent years have shown that some individuals with vegetative state or minimally conscious state can emerge to higher states of consciousness even years after injury. A minority of behaviorally unresponsive patients with vegetative state have also been shown to follow commands, or even communicate, using neuroimaging or electrophysiological techniques. These advances raise ethical questions that have important implications for clinical care. In this article, the authors argue that adopting a neuropalliative care approach can help clinicians provide ethical, compassionate care to these patients and their caregivers.
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Affiliation(s)
- Adeline L Goss
- Department of Neurology, University of California San Francisco, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143, USA.
| | - Claire J Creutzfeldt
- Department of Neurology, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA
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4
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Ullah S, Bin Ayaz S, Moukais IS, Qureshi AZ, Alumri T, Wani TA, Aldajani AA. Factors affecting functional outcomes of traumatic brain injury rehabilitation at a rehabilitation facility in Saudi Arabia. ACTA ACUST UNITED AC 2021; 25:169-175. [PMID: 32683395 PMCID: PMC8015482 DOI: 10.17712/nsj.2020.3.20190097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives: To identify the factors that affect disability after inpatient rehabilitation (IPR) in persons with traumatic brain injury (TBI). Methods: This retrospective study identified 140 patients aged ≥16 years who were admitted to the TBI rehabilitation unit at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia between 2015 and 2017. The collected data included demographic variables, TBI cause, coma duration, time from injury to IPR, LOS, and Functional Independence Measure (FIM) scores at IPR admission and discharge. Results: Majority of the patients were young males. The TBI was caused by motor vehicle accidents (MVA) in 95% of patients. The mean coma duration, time from injury to IPR admission, and LOS were 47±38, 264±357, and 75±52 days, respectively. The factors that were found to have an association with FIM change were time from injury to IPR admission (p=0.003, r=-0.250), admission FIM score (p=0.003, r=-0.253), and discharge FIM score (p<0.001, r=0.390). Employed patients had high FIM scores at admission (p=0.029, r=0.184) and discharge (p=0.003, r=0.252). Conclusion: Reduction in disability at discharge was positively associated with the severity of disability at admission and negatively with the time duration from injury to IPR admission, indicating a need to reduce time before admittance to an IPR setup. The high incidence of MVA causing TBI in a young male population strongly points to a need for appropriate measures of prevention.
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Affiliation(s)
- Sami Ullah
- Department of Physical Medicine and Rehabilitation, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail:
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5
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O’Donoghue C, Meixner C. A qualitative study of providers’ decision-making for cases involving neurobehavioral issues. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1788330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Cynthia O’Donoghue
- Communication Sciences and Disorders, James Madison University, Harrisonburg, USA
| | - Cara Meixner
- Graduate Psychology, James Madison University, Harrisonburg, USA
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6
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A Cross-Sectional Study of Treatments for Behavioral Disorders Following Traumatic Brain Injury: Comparison With French Recommendations. J Head Trauma Rehabil 2020; 34:E51-E60. [PMID: 30499933 DOI: 10.1097/htr.0000000000000452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To give a cross-sectional overview of ongoing management of behavioral disorders following traumatic brain injury (TBI) in a region of France, to compare this with recent recommendations from the French Society of Physical Medicine and Rehabilitation (SOFMER), and to evaluate associations between treatments and participant characteristics. SETTING Outpatients referred to medical or community-based facilities in a region of France. PARTICIPANTS One hundred twenty-nine adults with moderate to severe TBI, in the postacute period (over 3 months postinjury). DESIGN Cross-sectional cohort study. MAIN MEASURES Sociodemographic data, ongoing interventions including psychotherapy and medication, behavioral disorders assessed by the Behavioral Dysexecutive Syndrome Inventory (BDSI). RESULTS Thirty-three percent of participants received ongoing psychotherapy and 43% were on medication. The most prescribed medications were antidepressants (21%), neuroleptics (18%), anxiolytics (16%), and mood stabilizers (14%). Eighty-five participants (71%) presented a current Behavioral Dysexecutive Syndrome (BDS) according to the BDSI. These participants more frequently received treatment (P = .004), psychotherapy (P = .048), medications (often 2 or more) (P = .007), and particularly antiepileptic mood stabilizers (P = .037) compared with those without BDS. CONCLUSION Although recommended as first-line treatment, few participants with BDS received psychotherapy. Medications were overused, especially neuroleptics in view of their potential adverse effects. In contrast, recommended medications, such as mood stabilizers and β-blockers, did not appear to be highly prescribed whatever the evolution. Compliance with recommendations seemed insufficient.
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7
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Tate RL, Lane-Brown AT, Myles BM, Cameron ID. A longitudinal study of support needs after severe traumatic brain injury. Brain Inj 2020; 34:991-1000. [DOI: 10.1080/02699052.2020.1764101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Robyn L Tate
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Bridget M Myles
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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8
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McCarron RH, Gracey F, Bateman A. Detecting mental health problems after paediatric acquired brain injury: A pilot Rasch analysis of the strengths and difficulties questionnaire. Neuropsychol Rehabil 2020; 31:1048-1068. [PMID: 32401169 DOI: 10.1080/09602011.2020.1760111] [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] [Indexed: 01/26/2023]
Abstract
The parent-reported Strengths and Difficulties Questionnaire (SDQ-P) is commonly used to assess for mental health problems, but its psychometric properties have not been studied in the paediatric Acquired Brain Injury (ABI) population. This study investigated the properties of the SDQ-P and its subscales in this population using Rasch analysis. One hundred and forty-three SDQ-Ps and 123 Impact Supplements were analyzed. Sixty-nine percent of SDQ-Ps were completed by female carers, 59% of young people were male, and 58% had Traumatic Brain Injury (TBI). In this population the SDQ-P Total Difficulties Scale and the Conduct Problems subscale showed questionable construct validity. The individual subscales and Impact Supplement did not meet the criteria for reliability. Two items had disordered thresholds. The individual subscales showed mistargeting and 13-24% person misfit. Two items were significantly underdiscriminating. There was differential item functioning with age and time post-injury, and local dependence between subscale items. The Total Difficulties scale was multidimensional. The most easily endorsed items were in keeping with common symptoms of brain injury. These findings suggest the SDQ-P in its current form may not be a reliable and valid assessment measure for mental health difficulties in the paediatric ABI population and requires further investigation.
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Affiliation(s)
- Robyn Henrietta McCarron
- The Cambridge Centre for Paediatric Neuropsychological Rehabilitation, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Fergus Gracey
- The Cambridge Centre for Paediatric Neuropsychological Rehabilitation, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK.,Collaborations for Leadership in Applied Health Research and Care (CLAHRC) East of England Programme, National Institute of Health Research (NIHR), Cambridge, UK.,Department of Clinical Psychology, University of East Anglia, Norwich, UK
| | - Andrew Bateman
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,School of Health and Social Care, University of Essex, Colchester, UK
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9
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Characteristics and outcome of severe traumatic brain injuries based on occupational status. Eur J Trauma Emerg Surg 2020; 47:2035-2041. [PMID: 32306121 PMCID: PMC8629783 DOI: 10.1007/s00068-020-01372-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/06/2020] [Indexed: 11/17/2022]
Abstract
Purpose The association of TBI with socioeconomic characteristics of patients has not been studied extensively. The objective of this study was to analyse the differences in injury characteristics and outcome in TBI patients based on their occupational status. Methods Data on patients from 13 centres based in Austria, Croatia, Slovakia, Bosnia and Herzegovina, and Macedonia were included in the analysis. Demographic characteristics, injury characteristics, treatment and outcome at various post-injury stages were compared according to occupational status. Logistic regression was used to adjust for the effect of co-variates. ICU mortality, hospital mortality, 6 months mortality, and outcome at 6 months were used as dependent variables. Results Overall, 886 patients were analysed with a mean age of 45.5 years. High-level falls were most prevalent in the blue-collar group (19%), most low-level falls occurred in the retired group. Traffic accidents were most common in students. The injuries were most severe in the blue-collar group and students. Highest mortalities and unfavourable outcomes were in the retired, students and white-collar workers had the best outcomes. Compared to retired patients, all groups had higher odds of favourable outcome at 6 months after adjusting for co-variates—OR from 2.2 (95% CI 1.1–4.6) for entrepreneurs to 3.6 (95% CI 1.8–7.2) for the blue-collar group. Conclusion Our paper provides clues pertaining specifically to variations in patterns and outcomes of TBI according to occupational status which can inform prevention and planning of services and can serve to plan priorities for further research.
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10
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O'Neil J, Egan M, Marshall S, Bilodeau M, Pelletier L, Sveistrup H. Remotely Supervised Home-Based Intensive Exercise Intervention to Improve Balance, Functional Mobility, and Physical Activity in Survivors of Moderate or Severe Traumatic Brain Injury: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e14867. [PMID: 31599733 PMCID: PMC6812480 DOI: 10.2196/14867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/31/2019] [Accepted: 08/07/2019] [Indexed: 01/07/2023] Open
Abstract
Background Traumatic brain injury (TBI) may impact an individual physically, cognitively, socially, and emotionally. Poor balance, reduced mobility, and low daily physical activity often will require ongoing physical rehabilitation intervention. However, face-to-face specialized physiotherapy is not always accessible for individuals living in rural settings. Objective We will answer four questions: (1) What is the feasibility of a remotely supervised, home-based, intensive exercise intervention with survivors of moderate and severe TBI? (2) Does the frequency of remote supervision have an impact on the feasibility of completing a home-based intensive exercise program? (3) Does the frequency of remote supervision impact balance, functional mobility, and physical activity? (4) What is the lived experience of remote supervision for both survivors and caregivers? Methods Four participants will complete two intensive, 4-week (five days per week) home-based exercise interventions remotely supervised via synchronous videoconference. Each exercise intervention will have a goal of 160 to 300 repetitions or 60 minutes of tailored exercises to promote neuroplasticity and be defined as an intensive home-based exercise intervention. An alternating single-subject design will allow for the comparison between two frequencies of remote supervision, once weekly and five times weekly. Daily repeated outcome measures, pre- and postintervention outcome measures, and 1-month follow-up outcome measures will be collected to explore the effect on feasibility and physical variables. Daily outcome measures include step count and Five Times Sit-to-Stand test. Pre-post measures include assessment of quiet stance and the Community Balance and Mobility Scale. A semistructured interview will be completed at the end of each intervention segment to document the lived experience of both survivors and their study partners. Finally, five questionnaires will be used to understand the overall experience: the Mayo-Portland Adaptability Inventory-4 Participation Index, Satisfaction With Life Scale, Fall Efficacy Scale-International, Interpersonal Behavior Questionnaire, and System Usability Scale. Data will be analyzed following traditional single-subject methods of analysis. Results Ethics approval was received from both the Bruyère Research Institute and University of Ottawa review boards in March 2019. Recruitment is underway. Conclusions The proposed intervention is complex in nature due to the involvement of multiple technology sources and the inclusion of a complex dyad (survivors and caregivers) in a community setting. This type of research is timely given that alternative methods of physical intervention delivery are needed to facilitate gains in balance, mobility, physical activity among TBI survivors with limited access to clinical care, and the quality of the patients’ experience. International Registered Report Identifier (IRRID) PRR1-10.2196/14867
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Affiliation(s)
- Jennifer O'Neil
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Mary Egan
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Shawn Marshall
- Bruyère Research Institute, Ottawa, ON, Canada.,Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Martin Bilodeau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Luc Pelletier
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
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11
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Factors affecting functional outcome in patients with traumatic brain injury sequelae: Our single-center experiences on brain injury rehabilitation. Turk J Phys Med Rehabil 2019; 65:67-73. [PMID: 31453545 DOI: 10.5606/tftrd.2019.2281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/01/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the effect of rehabilitation on functional level of traumatic brain injury (TBI) patients and to examine the associated factors on functional gain in this patient population. Patients and methods Between October 2010 and November 2015, a total of 71 patients (63 males, 8 females; mean age 26.6±8.1 years; range, 18 to 56 years) who were admitted to our rehabilitation clinic with moderate-to-severe TBI were retrospectively analyzed. Functional recovery was assessed using the Functional Independence Measure (FIM) and Functional Ambulation Classification (FAC) scales. The patients were divided into two groups according to time from TBI to the initiation of rehabilitation: early (<6 months) and late (≥6 months). Possible predictive factors associated with FIM gain were evaluated. Results There was a significant improvement in the FIM scores from admission to discharge (p<0.001). There was a statistically significant difference in the FIM gain and FIM efficiency between the patient groups according to the initiation of rehabilitation (p<0.001). The FAC scores increased from admission to discharge, showing statistical significance (p<0.001). Duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis were found to be significant factors associated with FIM gain (p<0.001). Conclusion Our study results suggest that rehabilitation is effective for functional gain, particularly in the early period in patients with moderate- to-severe TBI and duration of rehabilitation, early rehabilitation, heterotopic ossification, and deep venous thrombosis are also predictors of functional improvement.
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12
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Cognitive and Motor Recovery and Predictors of Long-Term Outcome in Patients With Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100:1274-1282. [DOI: 10.1016/j.apmr.2018.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/28/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023]
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13
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Drapeau J, Gosselin N, Peretz I, McKerral M. Electrophysiological Responses to Emotional Facial Expressions Following a Mild Traumatic Brain Injury. Brain Sci 2019; 9:E142. [PMID: 31216634 PMCID: PMC6627801 DOI: 10.3390/brainsci9060142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to measure neural information processing underlying emotional recognition from facial expressions in adults having sustained a mild traumatic brain injury (mTBI) as compared to healthy individuals. We thus measured early (N1, N170) and later (N2) event-related potential (ERP) components during presentation of fearful, neutral, and happy facial expressions in 10 adults with mTBI and 11 control participants. Findings indicated significant differences between groups, irrespective of emotional expression, in the early attentional stage (N1), which was altered in mTBI. The two groups showed similar perceptual integration of facial features (N170), with greater amplitude for fearful facial expressions in the right hemisphere. At a higher-level emotional discrimination stage (N2), both groups demonstrated preferential processing for fear as compared to happiness and neutrality. These findings suggest a reduced early selective attentional processing following mTBI, but no impact on the perceptual and higher-level cognitive processes stages. This study contributes to further improving our comprehension of attentional versus emotional recognition following a mild TBI.
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Affiliation(s)
- Joanie Drapeau
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), IURDPM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC H3S 2J4, Canada.
- Departement of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada.
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, QC H3C 3J7, Canada.
| | - Nathalie Gosselin
- Departement of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada.
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, QC H3C 3J7, Canada.
| | - Isabelle Peretz
- Departement of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada.
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, QC H3C 3J7, Canada.
| | - Michelle McKerral
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), IURDPM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC H3S 2J4, Canada.
- Departement of Psychology, Université de Montréal, Montreal, QC H3C 3J7, Canada.
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What do Kids with Acquired Brain Injury Want? Mapping Neuropsychological Rehabilitation Goals to the International Classification of Functioning, Disability and Health. J Int Neuropsychol Soc 2019; 25:403-412. [PMID: 31050334 PMCID: PMC6499727 DOI: 10.1017/s1355617719000213] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To increase understanding of the community neuropsychological rehabilitation goals of young people with acquired brain injuries (ABIs). METHOD Three hundred twenty-six neuropsychological rehabilitation goals were extracted from the clinical records of 98 young people with ABIs. The participants were 59% male, 2-19 years old, and 64% had a traumatic brain injury. Goals were coded using the International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY). Descriptive statistical analysis was performed to assess the distribution of goals across the ICF-CY. Chi-squared and Cramer's V were used to identify demographic and injury-related associations of goal type. RESULTS The distribution of goals was 52% activities and participation (AP), 28% body functions (BF), 20% environmental factors (EF), and <1% body structures (BS). The number of EF goals increased with age at assessment (V = .14). Non-traumatic causes of ABIs were associated with more EF goals (V = .12). There was no association between sex or time post-injury and the distribution of goals across the ICF-CY. CONCLUSIONS Young people with ABIs have a wide range of community neuropsychological rehabilitation goals that require an individualized, context-sensitive, and interdisciplinary approach. Community neuropsychological rehabilitation services may wish to ensure they are resourced to focus intervention on AP, with increasing consideration for EF as a young person progresses through adolescence. The findings of this research support models of community neuropsychological rehabilitation that enable wellness by combining direct rehabilitative interventions with attention to social context and systemic working across agencies. (JINS, 2019, 25, 403-412).
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Forslund MV, Perrin PB, Røe C, Sigurdardottir S, Hellstrøm T, Berntsen SA, Lu J, Arango-Lasprilla JC, Andelic N. Global Outcome Trajectories up to 10 Years After Moderate to Severe Traumatic Brain Injury. Front Neurol 2019; 10:219. [PMID: 30923511 PMCID: PMC6426767 DOI: 10.3389/fneur.2019.00219] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/20/2019] [Indexed: 12/31/2022] Open
Abstract
Aims: Based on important predictors, global functional outcome after traumatic brain injury (TBI) may vary significantly over time. This study sought to: (1) describe changes in the Glasgow Outcome Scale-Extended (GOSE) score in survivors of moderate to severe TBI, (2) examine longitudinal GOSE trajectories up to 10 years after injury, and (3) investigate predictors of these trajectories based on socio-demographic and injury characteristics. Methods: Socio-demographic and injury characteristics of 97 TBI survivors aged 16-55 years were recorded at baseline. GOSE was used as a measure of TBI-related global outcome and assessed at 1-, 2-, 5-, and 10-year follow-ups. Hierarchical linear models were used to examine global outcomes over time and whether those outcomes could be predicted by: time, time*time, sex, age, partner relationship status, education, employment pre-injury, occupation, cause of injury, acute Glasgow Coma Scale score, length of post-traumatic amnesia (PTA), CT findings, and Injury Severity Score (ISS), as well as the interactions between each of the significant predictors and time*time. Results: Between 5- and 10-year follow-ups, 37% had deteriorated, 7% had improved, and 56% showed no change in global outcome. Better GOSE trajectories were predicted by male gender (p = 0.013), younger age (p = 0.012), employment at admission (p = 0.012), white collar occupation (p = 0.014), and shorter PTA length (p = 0.001). The time*time*occupation type interaction effect (p = 0.001) identified different trajectory slopes between survivors in white and blue collar occupations. The time*time*PTA interaction effect (p = 0.023) identified a more marked increase and subsequent decrease in functional level among survivors with longer PTA duration. Conclusion: A larger proportion of survivors experienced deterioration in GOSE scores over time, supporting the concept of TBI as a chronic health condition. Younger age, pre-injury employment, and shorter PTA duration are important prognostic factors for better long-term global outcomes, supporting the existing literature, whereas male gender and white collar occupation are vaguer as prognostic factors. This information suggests that more intensive and tailored rehabilitation programs may be required to counteract a negative global outcome development in survivors with predicted worse outcome and to meet their long-term changing needs.
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Affiliation(s)
- Marit V Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Svein A Berntsen
- Department of Physical Medicine and Rehabilitation, Sørlandet Hospital, Kristiansand, Norway
| | - Juan Lu
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, United States.,Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
| | - Juan Carlos Arango-Lasprilla
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain.,BioCruces Health Research Institute, Cruces University Hospital Barakaldo, Barakaldo, Spain
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
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16
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de Haan EHF, Seijdel N, Kentridge RW, Heywood CA. Plasticity versus chronicity: Stable performance on category fluency 40 years post-onset. J Neuropsychol 2019; 14:20-27. [PMID: 30768853 PMCID: PMC7079005 DOI: 10.1111/jnp.12180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/17/2019] [Indexed: 12/17/2022]
Abstract
What is the long-term trajectory of semantic memory deficits in patients who have suffered structural brain damage? Memory is, per definition, a changing faculty. The traditional view is that after an initial recovery period, the mature human brain has little capacity to repair or reorganize. More recently, it has been suggested that the central nervous system may be more plastic with the ability to change in neural structure, connectivity, and function. The latter observations are, however, largely based on normal learning in healthy subjects. Here, we report a patient who suffered bilateral ventro-medial damage after presumed herpes encephalitis in 1971. He was seen regularly in the eighties, and we recently had the opportunity to re-assess his semantic memory deficits. On semantic category fluency, he showed a very clear category-specific deficit performing better that control data on non-living categories and significantly worse on living items. Recent testing showed that his impairments have remained unchanged for more than 40 years. We suggest cautiousness when extrapolating the concept of brain plasticity, as observed during normal learning, to plasticity in the context of structural brain damage.
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Affiliation(s)
- Edward H F de Haan
- Department of Psychology, University of Amsterdam, The Netherlands.,Amsterdam Brain and Cognition (ABC) Center, University of Amsterdam, The Netherlands
| | - Noor Seijdel
- Department of Psychology, University of Amsterdam, The Netherlands.,Amsterdam Brain and Cognition (ABC) Center, University of Amsterdam, The Netherlands
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17
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Ates Bulut E, Karabay N, Soysal P, Isik AT. An elderly patient with Alzheimer's disease, normal pressure hydrocephalus and traumatic brain injury: presented with behavioral symptoms similar to behavioral variant frontotemporal dementia. Int J Neurosci 2018; 129:623-626. [PMID: 30475083 DOI: 10.1080/00207454.2018.1552690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is nondegenerative insult to brain from external mechanical forces. It may cause cognitive impairment, psychological problems in the long period. Besides traumatic brain injury also induces neuroinflammation and neurodegeneration process, and increases risk of dementia. It may cause various psychiatric complications such as depression, posttraumatic stress disorder, generalized anxiety disorder, and other cognitive and behavioral sequela according to site of involvement in the brain. METHODS We report a patient who has behavioral symptoms, amnesia and gait apraxy after TBI. Patient's symptoms were similar to behavioral variant Frontotemporal Dementia (bv FTD). RESULTS After detailed neurocognitive and radiologic evaluation he was diagnosed with Normal Pressure Hydrocephalus (NPH), and Alzheimer's Disease (AD) following TBI. CONCLUSION Comprehensive geriatric assessment, including detailed radiological examinations, if it is necessary, is recommended for the optimum management of elderly patients with cognitive and psychosocial problems in order to avoid misdiagnosis and inappropriate treatment.
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Affiliation(s)
- Esra Ates Bulut
- a Department of Geriatric Medicine , Dokuz Eylul University, Faculty of Medicine , Izmir , Turkey
| | - Nuri Karabay
- b Department of Radiology , Dokuz Eylul University, Faculty of Medicine , Izmir , Turkey
| | - Pinar Soysal
- c Department of Geriatric Medicine , Bezmialem Vakif University, Faculty of Medicine , Istanbul , Turkey
| | - Ahmet Turan Isik
- a Department of Geriatric Medicine , Dokuz Eylul University, Faculty of Medicine , Izmir , Turkey.,d Faculty of Medicine, Department of Geriatric Medicine, Unit for Aging Brain and Dementia , Dokuz Eylul University , Izmir , Turkey
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18
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Hammond FM, Giacino JT, Nakase Richardson R, Sherer M, Zafonte RD, Whyte J, Arciniegas DB, Tang X. Disorders of Consciousness due to Traumatic Brain Injury: Functional Status Ten Years Post-Injury. J Neurotrauma 2018; 36:1136-1146. [PMID: 30226400 DOI: 10.1089/neu.2018.5954] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Few studies have assessed the long-term functional outcomes of patients with a disorder of consciousness due to traumatic brain injury (TBI). This study examined functional status during the first 10 years after TBI among a cohort with disorders of consciousness (i.e., coma, vegetative state, minimally conscious state). The study sample included 110 individuals with TBI who were unable to follow commands prior to inpatient rehabilitation and for whom follow-up data were available at 1, 2, 5, and 10 years post-injury. The sample was subdivided into those who demonstrated command-following early (before 28 days post-injury) versus late (≥ 28 days post-injury or never). Functional Independence Measure (FIM) at 1, 2, 5, and 10 years following TBI was used to measure functional outcomes. Measureable functional recovery occurred throughout the 10-year period, with more than two thirds of the sample achieving independence in mobility and self-care, and about one quarter achieving independent cognitive function by 10 years. Following commands prior to 28 days was associated with greater functional independence at all outcome time-points. Multi-trajectory modeling of recovery of three FIM subscales (self-care, mobility, cognition) revealed four distinct prognostic groups with different temporal patterns of change on these subscales. More than half the sample achieved near-maximal recovery by 1 year post-injury, while the later command-following subgroups recovered over longer periods of time. Significant late functional decline was not observed in this cohort. Among a cohort of patients unable to follow commands at the time of inpatient rehabilitation, a substantial proportion achieved functional independence in self-care, mobility, and cognition. The proportion of participants achieving functional independence increased between 5 and 10 years post-injury. These findings suggest that individuals with disorders of consciousness may benefit from ongoing functional monitoring and updated care plans for at least the first decade after TBI.
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Affiliation(s)
- Flora M Hammond
- 1 Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana
| | - Joseph T Giacino
- 2 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Risa Nakase Richardson
- 3 Health Services Research and Development Service, Center of Innovation for Disability and Rehabilitation Research, and Defense and Veterans Brain Injury Center, James A. Haley Veterans Hospital, University of South Florida, Tampa, Florida.,4 College of Medicine, University of South Florida, Tampa, Florida
| | | | - Ross D Zafonte
- 6 Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - John Whyte
- 7 Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
| | - David B Arciniegas
- 8 Departments of Neurology and Psychiatry, Center for Mental Health, Marcus Institute for Brain Health, University of Colorado School of Medicine, Gunnison, Colorado
| | - Xinyu Tang
- 9 Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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19
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Spotlight on Neurotrauma Research in Canada's Leading Academic Centers. J Neurotrauma 2018; 35:1986-2004. [PMID: 30074875 DOI: 10.1089/neu.2018.29017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Mohamed Ludin S, Abdul Rashid N. Functional Outcomes and Health-Related Quality of Life After Severe Traumatic Brain Injury: A Review. Clin Nurs Res 2018; 29:433-439. [PMID: 30079766 DOI: 10.1177/1054773818792459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Throughout recovery, patients with severe traumatic brain injury (TBI) show physical and functional improvement, but continue to have cognitive and psychosocial problems. The aim of this article was to review the literature regarding the functional and health-related quality of life (HRQOL) outcomes in severe TBI. There were 15 articles reviewed, 13 of them were quantitative studies and two were narrative review. Most of the articles showed an improvement occurs rapidly at 6 months post-injury. There were several factors that influence the outcome after TBI, most of it was the Glasgow Coma Scale (GCS) on admission, age, educational level, duration of posttraumatic amnesia (PTA), and length of stay (LOS) in the Intensive Care Unit (ICU). Thus, health care workers should help the survivors of severe TBI in the recovery process to ensure the latter can attain maximum function and quality of life.
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21
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Eliacin J, Fortney S, Rattray NA, Kean J. Access to health services for moderate to severe TBI in Indiana: patient and caregiver perspectives. Brain Inj 2018; 32:1510-1517. [DOI: 10.1080/02699052.2018.1499964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Johanne Eliacin
- Department of Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush Department of Veterans Affairs Medical Center, Indianapolis, IN, USA
- Departments of Psychology, Indiana University Purdue University, Indianapolis, IN, USA
- Center for Health Services Research, Regenstrief Institute, Inc. Indianapolis, IN, USA
- Act Center of Indiana, Indianapolis, IN, USA
| | - Sarah Fortney
- Department of Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush Department of Veterans Affairs Medical Center, Indianapolis, IN, USA
- Departments of Psychology, Indiana University Purdue University, Indianapolis, IN, USA
| | - Nicholas A. Rattray
- Department of Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush Department of Veterans Affairs Medical Center, Indianapolis, IN, USA
- Department of Anthropology, Indiana University Purdue University, Indianapolis, IN, USA
| | - Jacob Kean
- Department of Health Services Research and Development, Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Population Health Sciences and Department of Communication Sciences and Disorders, University of Utah School of Medicine, Salt Lake City, UT, USA
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22
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Ludin SM, Rashid NA, Awang MS, Nor MBM. Functional Outcomes 6 Months After Severe Traumatic Brain Injury Following Admission Into Intensive Care Unit: A Cohort Study in Two Tertiary Hospitals. Clin Nurs Res 2018; 28:830-851. [PMID: 29618232 DOI: 10.1177/1054773818767551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe traumatic brain injury (TBI) survivors show physical and functional improvements but continue to have cognitive and psychosocial problems throughout recovery. However, the functional outcome of severe TBI in Malaysia is unknown. The objective of this study is to measure the functional outcomes of severe TBI within 6 months post-injury. A cohort study was done on 33 severe TBI survivors. The Glasgow Outcome Scale-Extended (GOSE) was used in this study. The mean age of the participants was 31.79 years (range: 16-73 years). The logistic regression model was statistically significant, χ²(5, N = 33) = 29.09, p < .001. The length of stay (LOS) in incentive care unit (p = .049, odds ratio = 6.062) and duration on ventilator (p = .048, odds ratio = 0.083) were good predictors of the functional outcomes. Future research should focus on larger sample size of severe TBI in Malaysia.
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Affiliation(s)
- Salizar M Ludin
- 1 International Islamic University Malaysia, Kuantan, Malaysia
| | | | - Mohamed S Awang
- 1 International Islamic University Malaysia, Kuantan, Malaysia
| | - Mohd B M Nor
- 1 International Islamic University Malaysia, Kuantan, Malaysia
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23
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Rojas N, Laguë-Beauvais M, Belisle A, Lamoureux J, AlSideiri G, Marcoux J, Maleki M, Alturki AY, Anchouche S, Alquraini H, Feyz M, Guise ED. Frontal assessment battery (FAB) performance following traumatic brain injury hospitalized in an acute care setting. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:319-330. [DOI: 10.1080/23279095.2017.1422506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Natalia Rojas
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
| | - Maude Laguë-Beauvais
- Traumatic Brain Injury Program, McGill University Health Center, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Arielle Belisle
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
| | - Julie Lamoureux
- Department of Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Ghusn AlSideiri
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Judith Marcoux
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Mohammed Maleki
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Abdulrahman Y. Alturki
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Neurosurgery, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sonia Anchouche
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Hanan Alquraini
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Center, Montreal, Quebec, Canada
| | - Elaine de Guise
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montreal, Quebec, Canada
- Research Institute, McGill University Health Center, Montreal, Quebec, Canada
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24
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Ndoumbe A, Ngoyong Edu PB, Simeu C, Takongmo S. Epidemiological Analysis of 135 Cases of Severe Traumatic Brain Injury Managed at a Surgical Intensive Care Unit. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojmn.2018.81010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Living Life After Traumatic Brain Injury: Phase 1 of a Longitudinal Qualitative Study. J Head Trauma Rehabil 2018; 33:E44-E52. [DOI: 10.1097/htr.0000000000000321] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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El-Menyar A, Consunji R, Al-Thani H, Mekkodathil A, Jabbour G, Alyafei KA. Pediatric Traumatic Brain Injury: a 5-year descriptive study from the National Trauma Center in Qatar. World J Emerg Surg 2017; 12:48. [PMID: 29151847 PMCID: PMC5678808 DOI: 10.1186/s13017-017-0159-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background The epidemiologic characteristics and outcomes of pediatric traumatic brain injury (pTBI) have not been adequately documented from the rapidly developing countries in the Arab Middle East. We aimed to describe the hospital-based epidemiologic characteristics, injury mechanisms, clinical presentation, and outcomes of pTBI and analyze key characteristics and determinant of pTBI that could help to make recommendations for policies to improve their care. Methods We conducted a retrospective observational study in a level 1 trauma center (2010-2014) for all pTBI patients. Data were analyzed and compared according to different patient age groups. Results Out of 945 traumatic brain injury patients, 167 (17.7%) were ≤ 18 years old with a mean age of 10.6 ± 5.9 and 81% were males. The rate of pTBI varied from 5 to 14 cases per 100,000 children per year. The most affected group was teenagers (15-18 years; 40%) followed by infants/toddlers (≤ 4 years; 23%). Motor vehicle crash (MVC; 47.3%) was the most frequent mechanism of injury followed by falls (21.6%). MVC accounted for a high proportion of pTBI among teenagers (77.3%) and adolescents (10-14 years; 48.3%). Fall was a common cause of pTBI for infants/toddlers (51.3%) and 5-9 years old group (30.3%). The proportion of brain contusion was significantly higher in adolescents (61.5%) and teenagers (58.6%). Teenagers had higher mean Injury Severity Scoring of 24.2 ± 9.8 and lower median (range) Glasgow Coma Scale of 3 (3-15) (P = 0.001 for all). The median ventilatory days and intensive care unit and hospital length of stay were significantly prolonged in the teenage group. Also, pTBI in teenage group showed higher association with pneumonia (46.4%) and sepsis (17.3%) than other age groups (P = 0.01). The overall mortality rate was 13% (n = 22); 11 died within the first 24 h, 7 died between the second and seventh day and 4 died one week post-admission. Among MVC victims, a decreasing trend of case fatality rate (CFR) was observed with age; teenagers had the highest CFR (85.7) followed by adolescents (75.0), young children (33.3), and infants/toddlers (12.5). Conclusions This local experience to describe the burden of pTBI could be a basis to adopt and form an efficient, tailored strategy for safety in the pediatric population.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Rafael Consunji
- Hamad Injury Prevention Program, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | | | | | - Gaby Jabbour
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Khalid A Alyafei
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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27
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Julien J, Joubert S, Ferland MC, Frenette L, Boudreau-Duhaime M, Malo-Véronneau L, de Guise E. Association of traumatic brain injury and Alzheimer disease onset: A systematic review. Ann Phys Rehabil Med 2017; 60:347-356. [DOI: 10.1016/j.rehab.2017.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/13/2017] [Accepted: 03/26/2017] [Indexed: 10/19/2022]
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28
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Howrey BT, Graham JE, Pappadis MR, Granger CV, Ottenbacher KJ. Trajectories of Functional Change After Inpatient Rehabilitation for Traumatic Brain Injury. Arch Phys Med Rehabil 2017; 98:1606-1613. [PMID: 28392325 PMCID: PMC5710828 DOI: 10.1016/j.apmr.2017.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 03/03/2017] [Accepted: 03/12/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine trajectories of functional recovery after rehabilitation for traumatic brain injury (TBI). DESIGN Prospective study. SETTING Inpatient rehabilitation hospitals in the Uniform Data System for Medical Rehabilitation. PARTICIPANTS A subset of individuals receiving inpatient rehabilitation services for TBI from 2002 to 2010 who also had postdischarge measurement of functional independence (N=16,583). INTERVENTIONS Inpatient rehabilitation. MAIN OUTCOMES MEASURES Admission, discharge, and follow-up data were obtained from the Uniform Data System for Medical Rehabilitation. We used latent class mixture models to examine recovery trajectories for both cognitive and motor functioning as measured by the FIM instrument. RESULTS Latent class models identified 3 trajectories (low, medium, high) for both cognitive and motor FIM subscales. Factors associated with membership in the low cognition trajectory group included younger age, male sex, racial/ethnic minority, Medicare or Medicaid (vs commercial or other insurance), comorbid conditions, and greater duration from injury date to rehabilitation admission date. Factors associated with membership in the low motor trajectory group included older age, racial/ethnic minority, Medicare or Medicaid coverage, comorbid conditions, open head injury, and greater duration to admission. CONCLUSIONS Standard approaches to assessing recovery patterns after TBI obscure differences between subgroups with trajectories that differ from the overall mean. Select demographic and clinical characteristics can help classify patients with TBI into distinct functional recovery trajectories, which can enhance both patient-centered care and quality improvement efforts.
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Affiliation(s)
- Bret T Howrey
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX.
| | - James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Monique R Pappadis
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
| | - Carl V Granger
- Department of Neurology, School of Medical and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX
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29
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Harbinson M, Zarshenas S, Cullen NK. Long-Term Functional and Psychosocial Outcomes After Hypoxic-Ischemic Brain Injury: A Case-Controlled Comparison to Traumatic Brain Injury. PM R 2017; 9:1200-1207. [PMID: 28512065 DOI: 10.1016/j.pmrj.2017.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/13/2017] [Accepted: 04/16/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite the increasing rate of survival from hypoxic-ischemic brain injury (HIBI), there is a paucity of evidence on the long-term functional outcomes after inpatient rehabilitation among these nontrauma patients compared to patients with traumatic brain injury (TBI). OBJECTIVES To compare functional and psychosocial outcomes of patients with HIBI to those of case-matched patients with TBI 4-11 years after brain insult. DESIGN Retrospective, matched case-controlled study. METHODS Data at the time of rehabilitation admission and discharge were collected as part of a larger acquired brain injury (ABI) database at Toronto Rehabilitation Institute (TRI) between 1999 and 2009. This study consisted of 11 patients with HIBI and 11 patients with TBI that attended the neuro-rehabilitation day program at TRI during a similar time frame and were matched on age, admission Functional Independence Measure (FIM) scores, and acute care length of stay (ALOS). At 4-11 years following brain insult, patients were reassessed using the FIM, Disability Rating Scale (DRS), Personal Health Questionnaire Depression Scale (PHQ-9), and the Mayo-Portland Adaptability Inventory 4 (MPAI-4). RESULTS At follow-up, patients with HIBI had significantly lower FIM motor and cognitive scores than patients with TBI (75.3 ± 20.6 versus 88.1 ± 4.78, P < .05, and 25.5 ± 5.80 versus 32.7 ± 2.54, P <.05, respectively) despite having a similar time frame postinsult (ie, 4-11 years). In addition, there were significant differences in motor and total FIM change from admission to follow-up between HIBI and TBI patients (P < .05). Patients with HIBI also had significantly lower scores on the DRS, PHQ-9, and total MPAI-4 at follow-up (P < .05). CONCLUSIONS The study results suggest that patients with HIBI achieve less long-term functional improvements compared to patients with TBI. Further research is warranted to compare the components of inpatient rehabilitation while adjusting for demographics and clinical characteristics between these 2 groups of patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Meredith Harbinson
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada(∗)
| | - Sareh Zarshenas
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada(†)
| | - Nora K Cullen
- Brain and Spine Program, Toronto Rehabilitation Institute-University Health Network, Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; West Park Healthcare Centre, 82 Buttonwood Ave, Toronto, ON M6M 2J5, Canada(‡).
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30
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McLafferty FS, Barmparas G, Ortega A, Roberts P, Ko A, Harada M, Nuño M, Black KL, Ley EJ. Predictors of improved functional outcome following inpatient rehabilitation for patients with traumatic brain injury. NeuroRehabilitation 2017; 39:423-30. [PMID: 27589512 DOI: 10.3233/nre-161373] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine factors associated with response to inpatient rehabilitation treatment among TBI patients. SETTING Inpatient rehabilitation service at a Level I trauma center. PARTICIPANTS Moderate-severe TBI patients ages ≥ 18years old admitted between January 1, 2002 and December 31, 2012. MAIN MEASURES Response to inpatient rehabilitation, measured by the Functional Independence Measure (FIM) score. DESIGN Retrospective cohort study. RESULTS Of 1,984 patients treated for TBI, 184 (10.8%) underwent inpatient rehabilitation. The largest proportion of patients improved in mobility (98.9%), followed by self-care (93.7%), communication/social cognition (84.0%), and sphincter control (65.7%). Of these, 99 (53.8%) improved by 2 or more levels of functional independence and were considered rehabilitation responders. Responders were younger (53.1 years vs. 63.8, p < 0.01), had longer average rehabilitation stays (15.4 days vs. 12.2, p < 0.01), and were less likely to have an admission SBP <100 mmHg (7.1% vs. 17.1%, p = 0.01). On multivariate analysis, normotension at admission (AOR 0.06, p = 0.01) and longer rehabilitation LOS (AOR 1.11, p < 0.01) were associated with a response to inpatient rehabilitation. CONCLUSION Of the TBI patients who qualified for same-center inpatient rehabilitation, approximately half responded to treatment. Longer rehabilitation time and normotension at admission predicted response to rehabilitation. Further efforts are necessary to identify and optimize TBI patients for inpatient rehabilitation.
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Affiliation(s)
- Fred S McLafferty
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Galinos Barmparas
- Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alicia Ortega
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Pamela Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ara Ko
- Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Megan Harada
- Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Miriam Nuño
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Keith L Black
- Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric J Ley
- Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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31
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Drapeau J, Gosselin N, Peretz I, McKerral M. Emotional recognition from dynamic facial, vocal and musical expressions following traumatic brain injury. Brain Inj 2016; 31:221-229. [DOI: 10.1080/02699052.2016.1208846] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Joanie Drapeau
- Centre de recherche interdisciplinaire en réadaptation (CRIR) – Centre de réadaptation Lucie-Bruneau (CRLB)
- Centre de recherche en neuropsychologie et cognition (CERNEC)
- Centre for Research on Brain, Language and Music (CRBLM) and International Laboratory for Brain, Music and Sound Research (BRAMS)
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Nathalie Gosselin
- Centre de recherche en neuropsychologie et cognition (CERNEC)
- Centre for Research on Brain, Language and Music (CRBLM) and International Laboratory for Brain, Music and Sound Research (BRAMS)
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Peretz
- Centre for Research on Brain, Language and Music (CRBLM) and International Laboratory for Brain, Music and Sound Research (BRAMS)
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Michelle McKerral
- Centre de recherche interdisciplinaire en réadaptation (CRIR) – Centre de réadaptation Lucie-Bruneau (CRLB)
- Centre de recherche en neuropsychologie et cognition (CERNEC)
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada
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Colantonio A, Salehi S, Kristman V, Cassidy JD, Carter A, Vartanian O, Bayley M, Kirsh B, Hébert D, Lewko J, Kubrak O, Mantis S, Vernich L. Return to work after work-related traumatic brain injury. NeuroRehabilitation 2016; 39:389-99. [DOI: 10.3233/nre-161370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Angela Colantonio
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto ON, Canada
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Sara Salehi
- Graduate Department of Rehabilitation Sciences, University of Toronto, Toronto, ON, Canada
| | - Vicki Kristman
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
- Institute for Work & Health, Toronto, ON, Canada
| | - J. David Cassidy
- Toronto Western Research Institute, University Health Network, Toronto, ON, Canada
| | - Angela Carter
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Oshin Vartanian
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Bonnie Kirsh
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto ON, Canada
| | - Debbie Hébert
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto ON, Canada
- Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - John Lewko
- Centre for Research in Human Development, Laurentian University, Sudbury, ON, Canada
| | - Olena Kubrak
- Public Services Health & Safety Association, Toronto, ON, Canada
| | - Steve Mantis
- Research Action Alliance on the Consequences of Work Injury, Thunder Bay, ON, Canada
| | - Lee Vernich
- Research Service Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Moreno JA, McKerral M. Relationships between risky sexual behaviour, dysexecutive problems, and mental health in the years following interdisciplinary TBI rehabilitation. Neuropsychol Rehabil 2016; 28:34-56. [PMID: 26872445 DOI: 10.1080/09602011.2015.1136222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Little is known about the long-term consequences of traumatic brain injury (TBI) regarding risky sexual behaviour. The objectives of the study were (1) to compare risky sexual behaviour in a sample of individuals with TBI having received interdisciplinary rehabilitation with that of healthy controls, and (2) to explore the relationships between risky sexual behaviour, executive functions, and mental health in individuals with TBI. The study group consisted of 42 individuals with TBI with a mean age of 37.9 years (SD = 9.7), 12.8 years of education (SD = 3.3), and 3.3 years post-injury (SD = 4.3). Healthy controls consisted of 47 participants, with a mean age of 37.6 years (SD = 10.7), and 13 years of education (SD = 3). Risky sexual behaviour was measured with the Sexual Risk Survey and executive function with the Dysexecutive Questionnaire. Mental health measures included the Generalised Anxiety Disorder Scale, and the Patient Health Questionnaire for depression. Compared to healthy controls, individuals with TBI reported more dysexecutive and mental health problems, without differences in risky sexual behaviour. In individuals with TBI, risky sexual behaviour was associated with behavioural, cognitive and emotional dysexecutive problems, but not with anxiety or depression. It was concluded that special attention should be given to individuals with TBI showing difficulties in executive functions given their association with risky sexual behaviour.
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Affiliation(s)
- Jhon Alexander Moreno
- a Center for Interdisciplinary Research in Rehabilitation (CRIR)-Centre de Réadaptation Lucie-Bruneau (CRLB) , Montréal , Canada
| | - Michelle McKerral
- b Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Department of Psychology , Université de Montréal , Montréal , Canada
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Stéfan A, Mathé JF. What are the disruptive symptoms of behavioral disorders after traumatic brain injury? A systematic review leading to recommendations for good practices. Ann Phys Rehabil Med 2016; 59:5-17. [DOI: 10.1016/j.rehab.2015.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/23/2015] [Accepted: 11/23/2015] [Indexed: 12/01/2022]
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The Relationship Between Postconcussion Symptoms and Sexual Quality of Life in Individuals with Traumatic Brain Injury. SEXUALITY AND DISABILITY 2015. [DOI: 10.1007/s11195-015-9414-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Whiting DL, Deane FP, Simpson GK, McLeod HJ, Ciarrochi J. Cognitive and psychological flexibility after a traumatic brain injury and the implications for treatment in acceptance-based therapies: A conceptual review. Neuropsychol Rehabil 2015; 27:263-299. [PMID: 26156228 DOI: 10.1080/09602011.2015.1062115] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This paper provides a selective review of cognitive and psychological flexibility in the context of treatment for psychological distress after traumatic brain injury, with a focus on acceptance-based therapies. Cognitive flexibility is a component of executive function that is referred to mostly in the context of neuropsychological research and practice. Psychological flexibility, from a clinical psychology perspective, is linked to health and well-being and is an identified treatment outcome for therapies such as acceptance and commitment therapy (ACT). There are a number of overlaps between the constructs. They both manifest in the ability to change behaviour (either a thought or an action) in response to environmental change, with similarities in neural substrate and mental processes. Impairments in both show a strong association with psychopathology. People with a traumatic brain injury (TBI) often suffer impairments in their cognitive flexibility as a result of damage to areas controlling executive processes but have a positive response to therapies that promote psychological flexibility. Overall, psychological flexibility appears a more overarching construct and cognitive flexibility may be a subcomponent of it but not necessarily a pre-requisite. Further research into therapies which claim to improve psychological flexibility, such as ACT, needs to be undertaken in TBI populations in order to clarify its utility in this group.
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Affiliation(s)
- Diane L Whiting
- a Liverpool Brain Injury Rehabilitation Unit , Liverpool Hospital , Liverpool , Australia.,b School of Psychology , University of Wollongong , Wollongong , Australia.,d Brain Injury Rehabilitation Research Group , Ingham Institute of Applied Medical Research , Liverpool , Australia
| | - Frank P Deane
- b School of Psychology , University of Wollongong , Wollongong , Australia
| | - Grahame K Simpson
- a Liverpool Brain Injury Rehabilitation Unit , Liverpool Hospital , Liverpool , Australia.,c John Walsh Centre for Rehabilitation Research , University of Sydney , Sydney , Australia.,d Brain Injury Rehabilitation Research Group , Ingham Institute of Applied Medical Research , Liverpool , Australia
| | - Hamish J McLeod
- e Institute of Health and Well-being , University of Glasgow , Glasgow , Scotland
| | - Joseph Ciarrochi
- f Institute of Positive Psychology & Education , Australian Catholic University , Strathfield , Australia
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Ulam F, Shelton C, Richards L, Davis L, Hunter B, Fregni F, Higgins K. Cumulative effects of transcranial direct current stimulation on EEG oscillations and attention/working memory during subacute neurorehabilitation of traumatic brain injury. Clin Neurophysiol 2015; 126:486-96. [DOI: 10.1016/j.clinph.2014.05.015] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/25/2014] [Accepted: 05/22/2014] [Indexed: 11/30/2022]
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LeBlanc J, de Guise E, Champoux MC, Couturier C, Lamoureux J, Marcoux J, Maleki M, Feyz M. Early conversational discourse abilities following traumatic brain injury: An acute predictive study. Brain Inj 2014; 28:951-8. [DOI: 10.3109/02699052.2014.888760] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Long-term neurological and neuropsychological outcome in patients with severe traumatic brain injury. Clin Neurol Neurosurg 2013; 115:2482-8. [DOI: 10.1016/j.clineuro.2013.09.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/08/2013] [Accepted: 09/29/2013] [Indexed: 11/24/2022]
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Community-based Rehabilitation Needs: Perceptions of Individuals with Brain Injury and Their Families in the Midwestern United States. AUSTRALIAN JOURNAL OF REHABILITATION COUNSELLING 2013. [DOI: 10.1017/jrc.2013.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study investigated the rehabilitation and services needs, rehabilitation goals and barriers of individuals with brain injury (n = 81, males = 59%, females = 41%, age range 18 to 87), and their family members (n = 19; females = 75%, age range 18 to 65), (ethnicity = white = 89%). Data were collected using a survey instrument and focus group interviews. A descriptive analysis of the quantitative data was conducted, while content analysis was used to analyse the qualitative data. Results suggest that individuals with brain injury and their families experience many unmet needs across the domains of employment, independent living, financial resources and housing. Family involvement was found to be important to community participation after brain injury.
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Rapp PE, Rosenberg BM, Keyser DO, Nathan D, Toruno KM, Cellucci CJ, Albano AM, Wylie SA, Gibson D, Gilpin AMK, Bashore TR. Patient Characterization Protocols for Psychophysiological Studies of Traumatic Brain Injury and Post-TBI Psychiatric Disorders. Front Neurol 2013; 4:91. [PMID: 23885250 PMCID: PMC3717660 DOI: 10.3389/fneur.2013.00091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/26/2013] [Indexed: 12/20/2022] Open
Abstract
Psychophysiological investigations of traumatic brain injury (TBI) are being conducted for several reasons, including the objective of learning more about the underlying physiological mechanisms of the pathological processes that can be initiated by a head injury. Additional goals include the development of objective physiologically based measures that can be used to monitor the response to treatment and to identify minimally symptomatic individuals who are at risk of delayed-onset neuropsychiatric disorders following injury. Research programs studying TBI search for relationships between psychophysiological measures, particularly ERP (event-related potential) component properties (e.g., timing, amplitude, scalp distribution), and a participant's clinical condition. Moreover, the complex relationships between brain injury and psychiatric disorders are receiving increased research attention, and ERP technologies are making contributions to this effort. This review has two objectives supporting such research efforts. The first is to review evidence indicating that TBI is a significant risk factor for post-injury neuropsychiatric disorders. The second objective is to introduce ERP researchers who are not familiar with neuropsychiatric assessment to the instruments that are available for characterizing TBI, post-concussion syndrome, and psychiatric disorders. Specific recommendations within this very large literature are made. We have proceeded on the assumption that, as is typically the case in an ERP laboratory, the investigators are not clinically qualified and that they will not have access to participant medical records.
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Affiliation(s)
- Paul E. Rapp
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Brenna M. Rosenberg
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - David O. Keyser
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Dominic Nathan
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | - Kevin M. Toruno
- Department of Military and Emergency Medicine, Uniformed Services UniversityBethesda, MD, USA
| | | | | | - Scott A. Wylie
- Neurology Department, Vanderbilt UniversityNashville, TN, USA
| | - Douglas Gibson
- Combat Casualty Care Directorate, Army Medical Research and Materiel CommandFort Detrick, MD, USA
| | - Adele M. K. Gilpin
- Arnold and Porter, LLPWashington, DC, USA
- Department of Epidemiology and Preventive Medicine, University of MarylandCollege Park, MD, USA
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Whyte J, Nakase-Richardson R, Hammond FM, McNamee S, Giacino JT, Kalmar K, Greenwald BD, Yablon SA, Horn LJ. Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch Phys Med Rehabil 2013; 94:1855-60. [PMID: 23732164 DOI: 10.1016/j.apmr.2012.10.041] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/05/2012] [Accepted: 10/26/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the 5-year outcomes of patients with traumatic brain injury (TBI) not following commands when admitted to acute inpatient rehabilitation. DESIGN Secondary analysis of prospectively collected data from the National Institute on Disability and Rehabilitation Research-funded Traumatic Brain Injury Model Systems (TBIMS). SETTING Inpatient rehabilitation hospitals participating in the TBIMS program. PARTICIPANTS Patients (N=108) with TBI not following commands at admission to acute inpatient rehabilitation were divided into 2 groups (early recovery: followed commands before discharge [n=72]; late recovery: did not follow commands before discharge [n=36]). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FIM items. RESULTS For the early recovery group, depending on the FIM item, 8% to 21% of patients were functioning independently at discharge, increasing to 56% to 85% by 5 years postinjury. The proportion functioning independently increased from discharge to 1 year, 1 to 2 years, and 2 to 5 years. In the late recovery group, depending on the FIM item, 19% to 36% of patients were functioning independently by 5 years postinjury. The proportion of independent patients increased significantly from discharge to 1 year and from 1 to 2 years, but not from 2 to 5 years. CONCLUSIONS Substantial proportions of patients admitted to acute inpatient rehabilitation before following commands recover independent functioning over as long as 5 years, particularly if they begin to follow commands before hospital discharge.
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Affiliation(s)
- John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA.
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Acceptance and Commitment Therapy (ACT) for Psychological Adjustment after Traumatic Brain Injury: Reporting the Protocol for a Randomised Controlled Trial. BRAIN IMPAIR 2013. [DOI: 10.1017/brimp.2012.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Following a severe traumatic brain injury (TBI) there is a complex presentation of psychological symptoms which may impact on recovery. Validated treatments addressing these symptoms for this group of people are limited. This article reports on the protocol for a single-centre, two-armed, Phase II Randomised Control Trial (RCT) to address the adjustment process following a severe TBI. Participants will be recruited from Liverpool Brain Injury Rehabilitation Unit and randomly allocated to one of two groups, Acceptance and Commitment Therapy (ACT) or an active control (Befriending). The active treatment group utilises the six core processes of ACT with the intention of increasing participation and psychological flexibility and reducing psychological distress. A number of primary and secondary outcome measures, administered at assessment, post-treatment and 1-month follow-up, will be used to assess clinical outcomes. The publication of the protocol before the trial results are available addresses fidelity criterion (intervention design) for RCTs. This ensures transparency in the RCT and that it meets the guidelines according to the CONSORT statement. The protocol has also been registered on the Australian New Zealand Clinical Trials Registry ACTRN12610000851066.
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Gouse H, Thomas KGF, Solms M. Neuropsychological, functional, and behavioral outcome in South African traumatic brain injury litigants. Arch Clin Neuropsychol 2012; 28:38-51. [PMID: 23151324 DOI: 10.1093/arclin/acs100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Few studies address the extent to which, during the process of litigation, individuals with moderate-to-severe traumatic brain injury might malinger in their performance on neuropsychological assessment batteries. This study explored whether financial settlement influenced neuropsychological test performance and activities of daily living in litigants (N = 31) who were tested and interviewed both during litigation and 1 year or more after case settlement. Results showed that neuropsychological test scores did not change from assessment during forensic proceedings to assessment after settlement. Although some improvement was evident in activities of daily living, the gains were small and their clinical significance questionable. We found no evidence that individuals with moderate-to-severe TBI, despite clear potential for secondary gain, malingered or delivered sub-optimal effort during neuropsychological evaluation taking place in the context of litigation.
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Affiliation(s)
- Hetta Gouse
- Department of Psychology, University of Cape Town, Cape Town, South Africa.
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Psychotherapeutic follow up of out patients with traumatic brain injury: Preliminary results of an individual neurosystemic approach. Ann Phys Rehabil Med 2012; 55:375-87. [DOI: 10.1016/j.rehab.2012.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 04/13/2012] [Accepted: 04/25/2012] [Indexed: 11/23/2022]
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de Guise E, LeBlanc J, Abouassaly M, Lin H, Lamoureux J, Champoux MC, Couturier C, Maleki M, Roger EP, Feyz M. The Relationship between Acute Functional Status and Long-Term Ambulation after Severe Traumatic Brain Injury. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/534856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective. To correlate long-term physical impairments of patients with severe traumatic brain injury (sTBI) based on their functional status in an acute care setting. Methods. 46 patients with sTBI participated in this prospective study. The Extended Glasgow Outcome Scale (GOSE) and the FIM instrument were rated at discharge from the acute care setting and at followup. The Functional Ambulation Classification (FAC), the Five-Meter Gait Speed, a quantified measure of negotiating stairs (Stair Climbing Speed and Rails used), and the functional reach test were rated at followup. Results. The subject with a score of 6 on the GOSE at discharge remained nonfunctional ambulator at followup. None of the subjects with a GOSE score of 5 became independent ambulators. Fifty percent of the subjects with a GOSE score of 4 were dependent ambulators. 100% of the subjects with a GOSE score of 2 or 3 at discharge were independent ambulators. A higher FIM score at discharge was associated with a greater chance of ambulating independently at 2 to 5 years after TBI (χKW22df). Conclusions. These data will allow physical health professionals in acute rehabilitation settings to provide more precise long-term physical outcome information to patients and families.
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Affiliation(s)
- Elaine de Guise
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada H3A 0G4
| | - Joanne LeBlanc
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Michel Abouassaly
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Howell Lin
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Julie Lamoureux
- Social and Preventive Medicine Department, University of Montreal, Montreal, QC, Canada H3C 3J7
| | - Marie-Claude Champoux
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Céline Couturier
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
| | - Mohammed Maleki
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada H3A 0G4
| | - Eric P. Roger
- Department of Neurosurgery, University at Buffalo, The State University of New York, Buffalo, NY 14260-1660, USA
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Centre (Montreal General Hospital), Montreal, QC, Canada H3G 1A4
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Kolakowsky-Hayner SA, Hammond FM, Wright J, Novack TA, Englander J, Diaz-Arrastia R, Dennison A, Sueno P. Ageing and traumatic brain injury: Age, decline in function and level of assistance over the first 10 years post-injury. Brain Inj 2012; 26:1328-37. [DOI: 10.3109/02699052.2012.706353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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LeBlanc J, de Guise E, Lamoureux J, Meyer K, Duplantie J, Thomas H, Abouassaly M, Champoux MC, Couturier C, Lin H, Lu L, Robinson C, Roger E, Maleki M, Feyz M. Criterion validity of a functional cognitive task in patients with severe traumatic brain injury. Brain Inj 2012; 26:1143-54. [PMID: 22630136 DOI: 10.3109/02699052.2012.666922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To verify criterion validity of measures from a functional cognitive task (FCT) carried out with patients with severe traumatic brain injury (sTBI) at 2-5 years post-injury. METHODS AND PROCEDURES Forty-six patients with sTBI took part in a long-term outcome study where the FCT and the Neurobehavioural Rating Scale-Revised (NBRS-R) were administered and the FIM™ instrument was rated. The FCT is a telephone information gathering task for evaluating functional cognitive skills. RESULTS Ten of 16 measures of the FCT were significantly correlated with similar or related concepts from the NBRS-R. The FIM™ cognitive score and the individual items of this score were significantly correlated with 13 of the FCT measures and with the percentage of amount of information gathered. Internal consistency was good for 13 of 16 measures. Overall, patients generally had mild difficulty on the FCT concepts. CONCLUSION The FCT can be used with patients with sTBI to evaluate certain aspects of functional cognition. It has good criterion validity and internal consistency, but additional research is required to further measure reliability and its applicability to other severity of TBI and to other phases of recovery.
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Affiliation(s)
- Joanne LeBlanc
- McGill University Health Centre-Montreal General Hospital, Montreal, Québec, Canada.
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McAllister TW, Tyler AL, Flashman LA, Rhodes CH, McDonald BC, Saykin AJ, Tosteson TD, Tsongalis GJ, Moore JH. Polymorphisms in the brain-derived neurotrophic factor gene influence memory and processing speed one month after brain injury. J Neurotrauma 2012; 29:1111-8. [PMID: 22188054 DOI: 10.1089/neu.2011.1930] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) plays a role in cognition, as well as neural survival and plasticity. There are several common polymorphisms in the BDNF gene, one of which (rs6265) is an extensively studied non-synonymous coding polymorphism (Val66Met) which has been linked to cognitive performance in healthy controls and some clinical populations. We hypothesized that the Met allele of rs6265 would be associated with poorer cognitive performance in individuals with mild-to-moderate traumatic brain injury, and that other polymorphisms in the BDNF gene would also affect cognition. Genotype at 9 single-nucleotide polymorphisms (SNPs) in the BDNF gene, and measures of speed of information processing, learning, and memory were assessed in 75 patients with mTBI and 38 healthy subjects. Consistent with previous reports, the Met allele of rs6265 was associated with cognition (slower processing speed) in the entire group. Two other SNPs were associated with processing speed in the mTBI group, but both are in linkage disequilibrium with rs6265, and neither remained significant after adjustment for rs6265 status. Within the mTBI group, but not the controls, 4 SNPs, but not rs6265, were associated with memory measures. These associations were not affected by adjustment for rs6265 status. Polymorphisms in BDNF influence cognitive performance shortly after mTBI. The results raise the possibility that a functional polymorphism other than rs6265 may contribute to memory function after mTBI.
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Affiliation(s)
- Thomas W McAllister
- Section of Neuropsychiatry, Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire 05756, USA.
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Santiago LA, Oh BC, Dash PK, Holcomb JB, Wade CE. A clinical comparison of penetrating and blunt traumatic brain injuries. Brain Inj 2012; 26:107-25. [DOI: 10.3109/02699052.2011.635363] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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