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Faulkner JW, Snell DL, Siegert RJ. Rasch analysis of the depression anxiety stress scales-21 (DASS-21) in a mild traumatic brain injury sample. Brain Inj 2024:1-9. [PMID: 39374032 DOI: 10.1080/02699052.2024.2411297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/24/2024] [Accepted: 09/26/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVE In this study, we evaluated the psychometric properties of the Depression Anxiety Stress Scales 21 items (DASS-21) in a mild traumatic brain injury (mTBI) sample. METHOD Treatment-seeking adults (n = 347) were recruited from outpatient rehabilitation services in New Zealand. Dimensionality, reliability, person separation index, and differential item functioning (DIF) of the DASS-21 were examined using Rasch analysis. RESULTS Initial analysis of the complete 21-item DASS showed poor overall fit due to problems with individual items. Fit to the Rasch model was excellent when treated as three composite scores. The stress subscale demonstrated adequate model fit, dimensionality and good reliability. For anxiety, fit was not good, reliability was unsatisfactory and DIF was evident on one item. When this item was removed, fit to the model was still inadequate as was reliability. DIF was also evident for depression, but when this item was removed, fit to the model was adequate. CONCLUSION The DASS-21 is a psychometrically sound measure of distress and stress for adults seeking treatment following mTBI. Ordinal to interval score conversion tables are provided to increase the precision of measurement. When assessing depression in a mTBI population, a 6-item depression subscale is recommended. Caution is advised in using the DASS-21 anxiety subscale alone.
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Affiliation(s)
- Josh W Faulkner
- School of Psychology, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Deborah L Snell
- Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - R J Siegert
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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2
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Urrutia-Ruiz C, Rombach D, Cursano S, Gerlach-Arbeiter S, Schoen M, Bockmann J, Demestre M, Boeckers TM. Deletion of the Autism-Associated Protein SHANK3 Abolishes Structural Synaptic Plasticity after Brain Trauma. Int J Mol Sci 2022; 23:ijms23116081. [PMID: 35682760 PMCID: PMC9181590 DOI: 10.3390/ijms23116081] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022] Open
Abstract
Autism spectrum disorders (ASDs) are characterized by repetitive behaviors and impairments of sociability and communication. About 1% of ASD cases are caused by mutations of SHANK3, a major scaffolding protein of the postsynaptic density. We studied the role of SHANK3 in plastic changes of excitatory synapses within the central nervous system by employing mild traumatic brain injury (mTBI) in WT and Shank3 knockout mice. In WT mice, mTBI triggered ipsi- and contralateral loss of hippocampal dendritic spines and excitatory synapses with a partial recovery over time. In contrast, no significant synaptic alterations were detected in Shank3∆11−/− mice, which showed fewer dendritic spines and excitatory synapses at baseline. In line, mTBI induced the upregulation of synaptic plasticity-related proteins Arc and p-cofilin only in WT mice. Interestingly, microglia proliferation was observed in WT mice after mTBI but not in Shank3∆11−/− mice. Finally, we detected TBI-induced increased fear memory at the behavioral level, whereas in Shank3∆11−/− animals, the already-enhanced fear memory levels increased only slightly after mTBI. Our data show the lack of structural synaptic plasticity in Shank3 knockout mice that might explain at least in part the rigidity of behaviors, problems in adjusting to new situations and cognitive deficits seen in ASDs.
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Affiliation(s)
- Carolina Urrutia-Ruiz
- Institute for Anatomy and Cell Biology, Albert Einstein Allee 11, 89081 Ulm, Germany; (C.U.-R.); (D.R.); (S.C.); (S.G.-A.); (M.S.); (J.B.); (M.D.)
| | - Daniel Rombach
- Institute for Anatomy and Cell Biology, Albert Einstein Allee 11, 89081 Ulm, Germany; (C.U.-R.); (D.R.); (S.C.); (S.G.-A.); (M.S.); (J.B.); (M.D.)
| | - Silvia Cursano
- Institute for Anatomy and Cell Biology, Albert Einstein Allee 11, 89081 Ulm, Germany; (C.U.-R.); (D.R.); (S.C.); (S.G.-A.); (M.S.); (J.B.); (M.D.)
| | - Susanne Gerlach-Arbeiter
- Institute for Anatomy and Cell Biology, Albert Einstein Allee 11, 89081 Ulm, Germany; (C.U.-R.); (D.R.); (S.C.); (S.G.-A.); (M.S.); (J.B.); (M.D.)
| | - Michael Schoen
- Institute for Anatomy and Cell Biology, Albert Einstein Allee 11, 89081 Ulm, Germany; (C.U.-R.); (D.R.); (S.C.); (S.G.-A.); (M.S.); (J.B.); (M.D.)
| | - Juergen Bockmann
- Institute for Anatomy and Cell Biology, Albert Einstein Allee 11, 89081 Ulm, Germany; (C.U.-R.); (D.R.); (S.C.); (S.G.-A.); (M.S.); (J.B.); (M.D.)
| | - Maria Demestre
- Institute for Anatomy and Cell Biology, Albert Einstein Allee 11, 89081 Ulm, Germany; (C.U.-R.); (D.R.); (S.C.); (S.G.-A.); (M.S.); (J.B.); (M.D.)
| | - Tobias M. Boeckers
- Institute for Anatomy and Cell Biology, Albert Einstein Allee 11, 89081 Ulm, Germany; (C.U.-R.); (D.R.); (S.C.); (S.G.-A.); (M.S.); (J.B.); (M.D.)
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Translational Biochemistry, 89081 Ulm, Germany
- Correspondence: ; Tel.: +49-731-5002-3220
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3
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Wu T, Sato F, Antona-Makoshi J, Gabler L, Giudice JS, Alshareef A, Yaguchi M, Masuda M, Margulies S, Panzer MB. Integrating Human and Non-Human Primate Data to Estimate Human Tolerances for Traumatic Brain Injury. J Biomech Eng 2021; 144:1129238. [PMID: 34897386 DOI: 10.1115/1.4053209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Indexed: 11/08/2022]
Abstract
Traumatic brain injury (TBI) contributes to a significant portion of the injuries resulting from motor vehicle crashes, falls, and sports collisions. The development of advanced countermeasures to mitigate these injuries requires a complete understanding of the tolerance of the human brain to injury. In this study, we developed a new method to establish human injury tolerance levels using an integrated database of reconstructed football impacts, sub-injurious human volunteer data, and non-human primate data. The human tolerance levels were analyzed using tissue-level metrics determined using harmonized species-specific finite element brain models. Kinematics-based metrics involving complete characterization of angular motion (e.g., DAMAGE) showed better power of predicting tissue-level deformation in a variety of impact conditions and were subsequently used to characterize injury tolerance. The proposed human brain tolerances for mild and severe TBI were estimated and presented in the form of injury risk curves based on selected tissue-level and kinematics-based injury metrics. The application of the estimated injury tolerances was finally demonstrated using real-world automotive crash data.
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Affiliation(s)
- Taotao Wu
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Fusako Sato
- Safety Research Division, Japan Automobile Research Institute, Tsukuba, Japan
| | | | - Lee Gabler
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - J Sebastian Giudice
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Ahmed Alshareef
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
| | - Masayuki Yaguchi
- Safety Research Division, Japan Automobile Research Institute, Tsukuba, Japan
| | - Mitsutoshi Masuda
- Safety Subcommittee, Japan Automobile Manufacturers Association, Inc., Tokyo, Japan
| | - Susan Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Matthew B Panzer
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA, USA
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4
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Zhang J, Chang Y, Ding S. Disrupted hypothalamic functional connectivity related to cognitive impairment after diffuse axonal injury. Medicine (Baltimore) 2021; 100:e27805. [PMID: 35049180 PMCID: PMC9191382 DOI: 10.1097/md.0000000000027805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
This study aims to investigate whether there is imaging evidence of disrupted hypothalamic functional connectivity (FC) in patients with diffuse axonal injury (DAI) and relationships with cognitive impairment.Resting-state functional magnetic resonance imaging (fMRI) data were acquired from acute patients with diagnosed DAI (n = 30) and healthy controls (HC) (n = 30). We first assessed hypothalamic FC with seed-based analysis. Furthermore, the lateral and medial hypothalamic seed was selected to show distinct functional connectivity in DAI. In addition, partial correlation was used to measure the clinical associations with the altered hypothalamic FC in DAI patients.Compared with HC, DAI group showed significantly increased hypothalamic FC with superior temporal gyrus, and the regions around the operculum. Furthermore, there was a significant negative correlation between the connectivity coefficient of hypothalamus to right and left superior temporal gyrus and the disability rating scale scores in DAI group. When the seed regions were divided into lateral and medial hypothalamus, except for increased connectivity of medial hypothalamus (P < .01 with correction), we more observed that decreased left lateral hypothalamic connectivity was positively correlated with mini-mental state examination (MMSE) scores.Our results suggest that there are alterations of hypothalamic FC in DAI and offer further understanding of clinical symptoms including related cognitive impairment.
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5
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Bohorquez-Montoya L, España LY, Nader AM, Furger RE, Mayer AR, Meier TB. Amygdala response to emotional faces in adolescents with persistent post-concussion symptoms. Neuroimage Clin 2020; 26:102217. [PMID: 32109760 PMCID: PMC7044530 DOI: 10.1016/j.nicl.2020.102217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/10/2020] [Accepted: 02/16/2020] [Indexed: 11/23/2022]
Abstract
Approximately 30% of adolescents with concussion develop persistent post-concussion symptoms (PPCS) that include emotional symptoms. Elevated amygdalae reactivity to emotional faces has been reported in a variety of psychopathologies characterized by emotional symptoms overlapping with those in PPCS. We tested the hypothesis that amygdalae reactivity to emotional faces in adolescents with PPCS+ is elevated compared to concussed adolescents without PPCS and healthy controls. Concussed adolescents (ages 14-18) with (PPCS+; n = 23) and without PPCS (PPCS-; n = 13) participated in visits at least 4 weeks post-injury. Adolescents without prior concussion served as controls (HC; n = 15). All participants completed a detailed clinical battery and a common emotional face processing task that involved matching of emotional faces or shapes. Compared to HC and PPCS-, adolescents with PPCS+ had elevated depression symptoms, anhedonia, general psychological symptoms, and anxiety symptoms. Contrary to our hypothesis, PPCS+ had lower amygdalae activity to the emotional faces versus shapes condition relative to HC and a trend for lower activity relative to PPCS-. There was a non-significant inverse association between anhedonia amygdalae activity in adolescents with PPCS. Results suggest that adolescents with PPCS have altered amygdalae activity during the processing of emotional face stimuli.
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Affiliation(s)
| | - Lezlie Y España
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Amy M Nader
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Robyn E Furger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, United States; Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, United States; Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, United States; Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States.
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6
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Yousefzadeh-Chabok S, Kapourchali FR, Ramezani S. Determinants of long-term health-related quality of life in adult patients with mild traumatic brain injury. Eur J Trauma Emerg Surg 2019; 47:839-846. [DOI: 10.1007/s00068-019-01252-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
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Abstract
Concussion, also referred to as mild traumatic brain injury (MTBI), is a common pediatric condition. This article reviews global perspectives on the epidemiology, treatment, and prognosis of concussion in children. A Pubmed search was conducted using Clinical Queries with the key terms "concussion" and "mild traumatic brain injury," and the search was limited to "children." The search strategy included meta-analyses, randomized controlled trials, clinical trials, and reviews. The majority of publications were from Canada and the United States. Prevalence estimates vary widely according to case definition and studied population. Due to under-reporting and to the widely varying definitions of concussion, it is difficult to estimate how common the condition is. Common causes of concussions include sports injuries, motor vehicle collisions, bicycle accidents, falls, and assaults. Diagnosis is mainly clinical. Because concussion results from a disturbance in brain function rather than structural injury, neuroimaging studies, such as computed tomography and magnetic resonance imaging, are not routinely recommended. Treatment generally involves physical and cognitive rest, with a gradual return to activities, whereas prolonged rest may actually worsen outcomes. Helmets when bicycling, skiing, snowboarding, motor biking, placing age limits on certain types of contact sports, and encouragement of fair play are recommended to decrease the impact of head injuries but they do not prevent concussions. Overall outcomes are generally favorable. The symptoms and signs of concussion usually resolve within 10 days; most patients recover in 48-72 hours. Global perspectives on management and prognosis are lacking. Concussions or MTBIs are common childhood injuries and the prognosis is good but information is predominantly from Canada and the USA. Research in other countries in particular low and middle income countries is vital to have a global perspective on MTBI.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong; PICU, The Hong Kong Children's Hospital, Hong Kong.
| | - Alexander K C Leung
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Alcy R Torres
- Department of Pediatrics, Division of Child Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA
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8
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Yehene E, Lichtenstern G, Harel Y, Druckman E, Sacher Y. Self-efficacy and acceptance of disability following mild traumatic brain injury: A pilot study. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:468-477. [DOI: 10.1080/23279095.2019.1569523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Einat Yehene
- School of Behavioural Sciences, The Academic College of Tel Aviv – Yaffo, Tel-Aviv Yaffo, Israel
- Tel-Hashomer Hospital, Sheba Medical Centre, Ramat Gan, Israel
| | - Gal Lichtenstern
- School of Behavioural Sciences, The Academic College of Tel Aviv – Yaffo, Tel-Aviv Yaffo, Israel
| | - Yirmi Harel
- Loewenstein Rehabilitation Centre, Raanana, Israel
| | - Eran Druckman
- School of Behavioural Sciences, The Academic College of Tel Aviv – Yaffo, Tel-Aviv Yaffo, Israel
| | - Yaron Sacher
- Loewenstein Rehabilitation Centre, Raanana, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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9
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Bomyea J, Flashman LA, Zafonte R, Andaluz N, Coimbra R, George MS, Grant GA, Marx CE, McAllister TW, Shutter L, Lang AJ, Stein MB. Associations between neuropsychiatric and health status outcomes in individuals with probable mTBI. Psychiatry Res 2019; 272:531-539. [PMID: 30616120 DOI: 10.1016/j.psychres.2018.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
Mild traumatic brain injury (mTBI) is a common occurrence, and may impact distal outcomes in a subgroup of individuals. Improved characterization of health outcomes and identification of factors associated with poor outcomes is needed to better understand the impact of mTBI, particularly in those with co-occurring posttraumatic stress disorder (PTSD). Participants in a data repository of the Injury and Traumatic Stress (INTRuST) Clinical Consortium (n = 625) completed functional disability [FD] and health-related quality of life [HRQOL] questionnaires, and a subset completed a neuropsychological assessment. FD and HRQOL were compared among participants with probable mTBI (mTBI), probable mTBI with PTSD (mTBI/PTSD), and health comparison participants (HC). Associations between symptoms, neuropsychological performance, and health outcomes were examined in those with probable mTBI with and without PTSD (n = 316). Individuals in the mTBI/PTSD group endorsed poorer health outcomes than those in the mTBI group, who endorsed poorer outcomes than those in the HC group. Individuals in either mTBI group performed worse than those in the HC on verbal learning and memory and psychomotor speed. Health outcomes were correlated with mental health and postconcussive symptoms, as well as neuropsychological variables. mTBI may adversely impact self-reported health, with the greatest effect observed in individuals with co-occurring mTBI/PTSD.
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Affiliation(s)
- Jessica Bomyea
- VA San Diego Healthcare System Center of Excellence for Stress and Mental Health, La Jolla, CA, USA; University of California, San Diego Department of Psychiatry, La Jolla, CA, USA; University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA.
| | - Laura A Flashman
- Dartmouth Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Hanover, NH, USA; University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA
| | - Ross Zafonte
- Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Womens Hospital, Harvard Medical School, Department of Physical Medicine and Rehabilitation, Boston, MA, USA; University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA
| | - Norberto Andaluz
- Department of Neurological Surgery, University of Louisville, USA
| | | | - Mark S George
- Ralph H. Johnson VA Medical Center, Psychiatry Division, Charleston, SC, USA; The Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston, SC, USA; University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA
| | - Gerald A Grant
- Stanford University Medical Center, Department of Neurology and Neurosciences, Stanford, CA, USA; University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA
| | - Christine E Marx
- Durham VA Medical Center, Durham, NC, USA; Duke University, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA; University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA
| | - Thomas W McAllister
- Dartmouth Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Department of Psychiatry, Hanover, NH, USA; Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN, USA; University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA
| | - Lori Shutter
- University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA
| | - Ariel J Lang
- VA San Diego Healthcare System Center of Excellence for Stress and Mental Health, La Jolla, CA, USA; University of California, San Diego Department of Psychiatry, La Jolla, CA, USA; University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA
| | - Murray B Stein
- University of California, San Diego Department of Psychiatry, La Jolla, CA, USA; University of California, San Diego Department of Family Medicine and Public Health, La Jolla, CA, USA; University of Pittsburgh, Department of Critical Care Medicine, Neurology, and Neurosurgery, Pittsburgh, PA, USA
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Theadom A, Barker-Collo S, Jones KM, Parmar P, Bhattacharjee R, Feigin VL. MLC901 (NeuroAiD II™) for cognition after traumatic brain injury: a pilot randomized clinical trial. Eur J Neurol 2018; 25:1055-e82. [PMID: 29611892 PMCID: PMC6055867 DOI: 10.1111/ene.13653] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/19/2018] [Indexed: 11/28/2022]
Abstract
Background and purpose Treatments to facilitate recovery after traumatic brain injury (TBI) are urgently needed. We conducted a 9‐month pilot, randomized placebo‐controlled clinical trial to examine the safety and potential effects of the herbal supplement MLC901 (NeuroAiD II™) on cognitive functioning following TBI. Methods Adults aged 18–65 years at 1–12 months after mild or moderate TBI were randomized to receive MLC901 (0.8 g capsules 3 times daily) or placebo for 6 months. The primary outcome was cognitive functioning as assessed by the CNS Vital Signs online neuropsychological test. Secondary outcomes included the Cognitive Failures Questionnaire, the Rivermead Post‐concussion Symptom Questionnaire (neurobehavioral sequelae), Quality of Life after Brain Injury, Hospital Anxiety and Depression Scale, Modified Fatigue Impact Scale and extended Glasgow Outcome Scale (physical disability). Assessments were completed at baseline and at 3‐, 6‐ and 9‐month follow‐up. Linear mixed‐effects models were conducted, with the primary outcome time‐point of 6 months. Results A total of 78 participants [mean age 37.5 ± 14.8 years, 39 (50%) female] were included in the analysis. Baseline variables were similar between groups (treatment group, n = 36; control group, n = 42). Linear mixed‐effects models controlling for time, group allocation, repeated measurements, adherence and baseline assessment scores revealed significant improvements in complex attention (P = 0.04, d = 0.6) and executive functioning (P = 0.04, d = 0.4) at 6 months in the MLC901 group compared with controls. There were no significant differences between the groups for neurobehavioral sequelae, mood, fatigue, physical disability or overall quality of life at 6 months. No serious adverse events were reported. Conclusions MLC901 was safe and well tolerated post‐TBI. This study provided Class I/II evidence that, for patients with mild to moderate TBI, 6 months of MLC901 improved cognitive functioning.
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Affiliation(s)
- A Theadom
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland
| | - S Barker-Collo
- Department of Psychology, University of Auckland, Auckland, New Zealand
| | - K M Jones
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland
| | - P Parmar
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland
| | - R Bhattacharjee
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland
| | - V L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland
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11
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van Heugten C, Renaud I, Resch C. The role of early intervention in improving the level of activities and participation in youths after mild traumatic brain injury: a scoping review. Concussion 2017; 2:CNC38. [PMID: 30202580 PMCID: PMC6093851 DOI: 10.2217/cnc-2016-0030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/13/2017] [Indexed: 12/24/2022] Open
Abstract
Mild traumatic brain injury in children can lead to persistent cognitive and physical symptoms which can have a negative impact on activities and participation in school and at play. Preventive treatment strategies are preferred because these symptoms are often not recognized and therefore not treated adequately. In this review clinical studies investigating interventions directed at pediatric mild traumatic brain injury are summarized, and clinical recommendations and directions for the future are provided. Results show that the literature is scarce and more high quality studies are needed. Information and education about the injury and its consequences are recommended, with additional follow-up consultation, including individualized advice and reassurance. The interventions should be family-centered and, ideally, the return to activity and participation should be graded and done step-by-step.
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Affiliation(s)
- Caroline van Heugten
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands.,School for Mental Health & Neuroscience, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands.,School for Mental Health & Neuroscience, Faculty of Health, Medicine & Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht, The Netherlands
| | - Irene Renaud
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht, The Netherlands.,Revant Rehabilitation Center, Breda, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht, The Netherlands.,Revant Rehabilitation Center, Breda, The Netherlands
| | - Christine Resch
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Center, Maastricht, The Netherlands
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12
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Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology. J Trauma Acute Care Surg 2017; 81:743-7. [PMID: 27116408 DOI: 10.1097/ta.0000000000001088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. METHODS Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. RESULTS Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61.6%), the neurosurgery group had the highest proportion of intensive care unit admission (29.8%), and the neurology group had the longest emergency department stay (7.5 hours), there were no significant differences in duration of hospital stay, in-hospital complications, and readmission within 30 days. CONCLUSIONS Although there were differences in use of health care resources, and the proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma, most clinical outcomes were similar in INOMHI patients admitted to trauma surgery, neurosurgery, or neurology in our institution. A rotational policy of admitting INOMHI patients is feasible among services with expertise in and commitment to the care of these patients. LEVEL OF EVIDENCE Therapeutic/care management study, level IV.
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Zhou Y. Abnormal structural and functional hypothalamic connectivity in mild traumatic brain injury. J Magn Reson Imaging 2016; 45:1105-1112. [PMID: 27467114 DOI: 10.1002/jmri.25413] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/19/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate whether there is imaging evidence of hypothalamic injury in patients with mild traumatic brain injury (MTBI), which is a major public health problem due to the high prevalence and difficulty in diagnosis and treatment. MATERIALS AND METHODS Twenty-four patients (mean age 34.2, range, 18-56 years) with symptomatic MTBI and 22 age-matched healthy controls (mean age 37.0, range 20-61 years) participated in the study. Diffusion kurtosis imaging was performed with diffusion-weighted images acquired along 30 gradient directions and three b-values (b = 0, 1000, 2000 s/mm2 ) based on a twice-refocused spin-echo sequence with a 3T magnetic resonance imaging (MRI) scanner. Resting-state functional (f)MRI with standard echo planar imaging (EPI) were performed to localize the resting-state networks (RSN) and hypothalamic functional connectivity. RESULTS There were significantly reduced mean kurtosis (P = 0.0092) and radial kurtosis (P = 0.0078) in patients as compared to controls in the hypothalamus. Furthermore, there was a significant negative correlation (r = -0.675, P = 0.0007) between radial kurtosis in the hypothalamus and fatigue severity scale in patients. The MTBI group also showed disrupted hypothalamic RSNs, with significantly decreased positive connectivity in medial prefrontal cortex, inferior posterior parietal, and cingulate regions but increased connectivity in the peri-hypothalamic regions and cerebellum, together with significantly decreased negative RSNs in visual and bilateral premotor areas (cluster corrected P < 0.05). CONCLUSION Our results show disruption of functional and structural hypothalamic connectivity in patients with MTBI, and might further the understanding of an array of clinical symptoms in MTBI such as sleep disturbance and fatigue. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:1105-1112.
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Affiliation(s)
- Yongxia Zhou
- Department of Radiology / Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
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Donnan J, Walsh S, Fortin Y, Gaskin J, Sikora L, Morrissey A, Collins K, MacDonald D. Factors associated with the onset and progression of neurotrauma: A systematic review of systematic reviews and meta-analyses. Neurotoxicology 2016; 61:234-241. [PMID: 27006002 DOI: 10.1016/j.neuro.2016.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/11/2016] [Indexed: 01/07/2023]
Abstract
Neurotrauma, including traumatic brain injury (TBI) and spinal cord injury (SCI), is a preventable condition that imposes an important burden on the Canadian society. In this study, the current evidence on risk factors for the onset and progression of neurotrauma is systematically reviewed and synthesized. Searches of the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Medline and Medline in Process (via OVID), EMBASE and PsycINFO from inception to February 2013 were conducted to identify relevant systematic reviews and meta-analyses published in English or French. Two referees screened and assessed the quality of the studies using the AMSTAR tool. Thirty-two studies examined at least one risk factor for the onset of neurotrauma. Thirteen studies passed the quality assessment and the majority evaluated the impact of protective equipment in sports. Helmets effectively reduce TBI from bicycling, skiing, snowboarding, ice hockey and motorcycling. There was no evidence of a protective effect of helmets for SCI. No studies contributed evidence on risk factors for the onset of SCI. Of two studies examining risk factors for the progression of neurotrauma, only injury severity was found to be associated with poorer post-injury outcomes. Substantial evidence supports the use of helmets for the prevention of TBI in sports and motorcycling and face shields in ice hockey. Addressing bicycle helmet legislation across Canada may be an effective option for reducing TBI caused by bicycle accidents. Limited evidence on relevant risk factors for spinal cord injuries and neurotrauma progression was available.
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Affiliation(s)
- Jennifer Donnan
- School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, NL, Canada.
| | - Stephanie Walsh
- Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Yannick Fortin
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada
| | - Janet Gaskin
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Morrissey
- School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, NL, Canada
| | - Kayla Collins
- School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, NL, Canada
| | - Don MacDonald
- School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, NL, Canada
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Losoi H, Silverberg ND, Wäljas M, Turunen S, Rosti-Otajärvi E, Helminen M, Luoto TM, Julkunen J, Öhman J, Iverson GL. Recovery from Mild Traumatic Brain Injury in Previously Healthy Adults. J Neurotrauma 2015; 33:766-76. [PMID: 26437675 DOI: 10.1089/neu.2015.4070] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This prospective longitudinal study reports recovery from mild traumatic brain injury (MTBI) across multiple domains in a carefully selected consecutive sample of 74 previously healthy adults. The patients with MTBI and 40 orthopedic controls (i.e., ankle injuries) completed assessments at 1, 6, and 12 months after injury. Outcome measures included cognition, post-concussion symptoms, depression, traumatic stress, quality of life, satisfaction with life, resilience, and return to work. Patients with MTBI reported more post-concussion symptoms and fatigue than the controls at the beginning of recovery, but by 6 months after injury, did not differ as a group from nonhead injury trauma controls on cognition, fatigue, or mental health, and by 12 months, their level of post-concussion symptoms and quality of life was similar to that of controls. Almost all (96%) patients with MTBI returned to work/normal activities (RTW) within the follow-up of 1 year. A subgroup of those with MTBIs and controls reported mild post-concussion-like symptoms at 1 year. A large percentage of the subgroup who had persistent symptoms had a modifiable psychological risk factor at 1 month (i.e., depression, traumatic stress, and/or low resilience), and at 6 months, they had greater post-concussion symptoms, fatigue, insomnia, traumatic stress, and depression, and worse quality of life. All of the control subjects who had mild post-concussion-like symptoms at 12 months also had a mental health problem (i.e., depression, traumatic stress, or both). This illustrates the importance of providing evidence-supported treatment and rehabilitation services early in the recovery period.
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Affiliation(s)
- Heidi Losoi
- 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland .,2 Institute of Behavioural Sciences, University of Helsinki , Helsinki, Finland
| | - Noah D Silverberg
- 3 Division of Physical Medicine and Rehabilitation, GF Strong Rehab Centre, University of British Columbia , Vancouver, British Columbia, Canada
| | - Minna Wäljas
- 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland
| | - Senni Turunen
- 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland
| | - Eija Rosti-Otajärvi
- 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland
| | - Mika Helminen
- 4 School of Health Sciences, University of Tampere and Science Center , Pirkanmaa Hospital District, Tampere, Finland
| | - Teemu M Luoto
- 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland
| | - Juhani Julkunen
- 2 Institute of Behavioural Sciences, University of Helsinki , Helsinki, Finland
| | - Juha Öhman
- 1 Department of Neurosciences and Rehabilitation, Tampere University Hospital , Tampere, Finland
| | - Grant L Iverson
- 5 Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown Navy Yard, Charlestown, Massachusetts; Spaulding Rehabilitation Hospital; and Red Sox Foundation and Massachusetts General Hospital Home Base Program , Boston, Massachusetts
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Jagnoor J, Cameron I. Mild traumatic brain injury and motor vehicle crashes: limitations to our understanding. Injury 2015; 46:1871-4. [PMID: 25287066 DOI: 10.1016/j.injury.2014.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/30/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Jagnoor Jagnoor
- John Walsh Centre for Rehabilitation Research, Sydney, Australia.
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Sydney, Australia.
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17
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The effect of stromal cell-derived factor 1 in the migration of neural stem cells. Cell Biochem Biophys 2015; 70:1609-16. [PMID: 25241080 DOI: 10.1007/s12013-014-0103-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Neural stem cells (NSCs) have widely been used in the treatment of human neurological disorders as cell therapy via intracerebral or intraventricular infusion. However, the migration mechanism required for NSCs homing and recruitment remains to be elucidated. Recently, SDF-1/CXCR4 axis was shown to be responsible for in cell migration and differentiation during the neural development stage and involved in the pathophysiological process of neurological disorders. In this study, we investigated the effect of SDF-1 in migration of NSCs in vitro and in vivo. The expression of CXCR4 receptor was examined by immunocytochemistry and RT-PCR. The migratory ability of NSCs induced by SDF-1 was assessed by transwell chemotaxis assay. The traumatic brain injury rat model was well established, and the recruitment of NSCs and expression of SDF-1 were investigated in vivo. Our findings demonstrated that SDF-1, in vitro, significantly induced the migratory of NSCs in a dose-dependent manner. An overexpression of neural stem cell marker Nestin in the hippocampus was observed after TBI, and the expressions of SDF-1 surrounding the lesion areas were significantly increased. Our results suggested that the migration of NSCs was activated by chemotactic effect of SDF-1. It was also proved the relevance of SDF-1 in the migration of endogenous NSCs after brain injury. Taken together, these results demonstrated that SDF-1/CXCR4 axis may play crucial role in the migration of Nestin-positive cell after brain injury.
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Goddeyne C, Nichols J, Wu C, Anderson T. Repetitive mild traumatic brain injury induces ventriculomegaly and cortical thinning in juvenile rats. J Neurophysiol 2015; 113:3268-80. [PMID: 25695652 DOI: 10.1152/jn.00970.2014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/13/2015] [Indexed: 11/22/2022] Open
Abstract
Traumatic brain injury (TBI) most frequently occurs in pediatric patients and remains a leading cause of childhood death and disability. Mild TBI (mTBI) accounts for nearly 75% of all TBI cases, yet its neuropathophysiology is still poorly understood. While even a single mTBI injury can lead to persistent deficits, repeat injuries increase the severity and duration of both acute symptoms and long-term deficits. In this study, to model pediatric repetitive mTBI (rmTBI) we subjected unrestrained juvenile animals (postnatal day 20) to repeat weight-drop impacts. Animals were anesthetized and subjected to sham injury or rmTBI once per day for 5 days. Magnetic resonance imaging (MRI) performed 14 days after injury revealed marked cortical atrophy and ventriculomegaly in rmTBI animals. Specifically, beneath the impact zone the thickness of the cortex was reduced by up to 46% and the area of the ventricles increased by up to 970%. Immunostaining with the neuron-specific marker NeuN revealed an overall loss of neurons within the motor cortex but no change in neuronal density. Examination of intrinsic and synaptic properties of layer II/III pyramidal neurons revealed no significant difference between sham-injured and rmTBI animals at rest or under convulsant challenge with the potassium channel blocker 4-aminopyridine. Overall, our findings indicate that the neuropathological changes reported after pediatric rmTBI can be effectively modeled by repeat weight drop in juvenile animals. Developing a better understanding of how rmTBI alters the pediatric brain may help improve patient care and direct "return to game" decision making in adolescents.
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Affiliation(s)
- Corey Goddeyne
- University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona; and School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Joshua Nichols
- University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona; and School of Life Sciences, Arizona State University, Tempe, Arizona
| | - Chen Wu
- University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona; and
| | - Trent Anderson
- University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona; and
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Polinder S, Haagsma JA, van Klaveren D, Steyerberg EW, van Beeck EF. Health-related quality of life after TBI: a systematic review of study design, instruments, measurement properties, and outcome. Popul Health Metr 2015; 13:4. [PMID: 25722656 PMCID: PMC4342191 DOI: 10.1186/s12963-015-0037-1] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/02/2015] [Indexed: 12/03/2022] Open
Abstract
Measurement of health-related quality of life (HRQL) is essential to quantify the subjective burden of traumatic brain injury (TBI) in survivors. We performed a systematic review of HRQL studies in TBI to evaluate study design, instruments used, methodological quality, and outcome. Fifty-eight studies were included, showing large variation in HRQL instruments and assessment time points used. The Short Form-36 (SF-36) was most frequently used. A high prevalence of health problems during and after the first year of TBI was a common finding of the studies included. In the long term, patients with a TBI still showed large deficits from full recovery compared to population norms. Positive results for internal consistency and interpretability of the SF-36 were reported in validity studies. The Quality of Life after Brain Injury instrument (QOLIBRI), European Brain Injury Questionnaire (EBIQ), Child Health Questionnaire (CHQ), and the World Health Organization Quality of Life short version (WHOQOL-BREF) showed positive results, but evidence was limited. Meta-analysis of SF-36 showed that TBI outcome is heterogeneous, encompassing a broad spectrum of HRQL, with most problems reported in the physical, emotional, and social functioning domain. The use of SF-36 in combination with a TBI-specific instrument, i.e., QOLIBRI, seems promising. Consensus on preferred methodologies of HRQL measurement in TBI would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of the burden of TBI.
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Affiliation(s)
- Suzanne Polinder
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
| | - Juanita A Haagsma
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
| | - David van Klaveren
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
| | - Ewout W Steyerberg
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
| | - Ed F van Beeck
- Erasmus MC, Department of Public Health, PO Box 2040, 3000 Rotterdam, CA The Netherlands
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20
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Does isolated traumatic subarachnoid hemorrhage affect outcome in patients with mild traumatic brain injury? J Head Trauma Rehabil 2014; 28:442-5. [PMID: 22832372 DOI: 10.1097/htr.0b013e31825e19e5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The importance of isolated traumatic subarachnoid hemorrhage (SAH) in relation to functional outcome in patients with mild traumatic brain injury (TBI) has not been frequently studied. The aim of this study was to compare the impact of isolated SAH with normal computed tomographic (CT) scan on outcome of patients with mild TBI. METHODS This is a retrospective study of clinical records and CT scans of all patients with mild TBI (Glasgow Coma Scale score ≥13) evaluated from January 1, 2010, to March 15, 2010, at our institution. The patients were divided into 2 groups: isolated SAH and normal CT scan. The telephonic Glasgow Outcome Scale-Extended, Rivermead Post-Concussion Symptoms Questionnaire (RPCSQ), and Rivermead Head Injury Follow-up Questionnaire (RHFUQ) scores were used to assess outcome after 1 year of injury. Independent sample t test in SPSS was used to assess difference in outcome. RESULTS A total of 1149 patients with mild TBI were evaluated during study period. Among them, 34 (2.9%) patients had isolated SAH. Twenty-eight patients were male and 6 were female, with a mean age of 36.5 years. Subarachnoid hemorrhage was cortical in 19 (55.9%) patients, interhemispheric in 3 (8.8%) patients, Sylvian fissure in 2 (5.9%) patients, and basal cisternal in 1 (2.9%) patient. Nine (26.5%) patients had SAH at multiple locations. The mean RPCSQ and RHFUQ scores for patients with isolated SAH were 1.38 ± 2.40 and 1.11 ±3.305, respectively. The mean RPCSQ and RHFUQ scores for patients with normal CT scans were 0.40 ± 1.549 and 0.533 ± 1.59, respectively. There was no significant difference in the outcome scores between the SAH and the normal CT scan groups (RHFUQ, P = .45; RPCSQ, P = .248). CONCLUSION In our study sample of patients with mild TBI, there is no difference in outcome of patients with isolated SAH compared with those with normal CT scans 1 year after injury.
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21
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Bohman K, Stigson H, Krafft M. Long-term medical consequences for child occupants 0 to 12 years injured in car crashes. TRAFFIC INJURY PREVENTION 2014; 15:370-378. [PMID: 24471361 DOI: 10.1080/15389588.2013.826799] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE There is limited knowledge of the long-term medical consequences for children injured in car crashes. Thus, in the event of injury, the aim of the study was to specify patterns and risks of injuries resulting in permanent medical impairment of children (0-12 years) for different body regions and injury severity levels, according to Abbreviated Injury Scale (AIS). The aim was also to compare the impairment outcome with adults. METHODS Data were obtained from the Folksam insurance company, including reported car crashes from 1998 to 2010 with at least one injured child 0-12 years of age. In all, 2619 injured children with 3704 reported medical diagnoses were identified. All injuries were classified according to the AIS 2005 revision. If the child had not recovered within 1 year postinjury an assessment of permanent medical impairment (PMI) was made by one or several medical specialists. RESULTS In all, 55 children sustained 59 injuries resulting in PMI of which 75 percent were at AIS 1 or AIS 2. The head and cervical spine were the body regions sustaining the most injuries resulting in PMI. Sixty-eight percent of all injuries resulting in PMI were AIS 1 injuries to the cervical spine, with the majority occurring in frontal or rear impacts. Given an injury to the cervical spine, the risk of injuries resulting in PMI was 3 percent, and older children (≥6 years) had a significantly higher risk (3% versus 1%) than younger children. The head was the second most commonly injured body region with injuries resulting in PMI (12/59), which were predominantly AIS 2+. In addition, mild traumatic brain injuries at AIS 1 were found to lead to PMI. Whereas for children the injuries leading to PMI were primarily limited to the head and cervical spine, adults sustained injuries that led to PMI from a more diverse distribution of body regions. CONCLUSION The pattern of injuries resulting in permanent medical impairment is different for children and adults; therefore, safety priorities for children need to be based on child data. The majority of those injuries leading to PMI were at lower AIS levels. Furthermore, AIS 1 cervical spine and AIS 1+ head injuries should be given priority concerning mitigation of long-term consequences for children.
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Zhou Y, Kierans A, Kenul D, Ge Y, Rath J, Reaume J, Grossman RI, Lui YW. Mild traumatic brain injury: longitudinal regional brain volume changes. Radiology 2013; 267:880-90. [PMID: 23481161 DOI: 10.1148/radiol.13122542] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate longitudinal changes in global and regional brain volume in patients 1 year after mild traumatic brain injury (MTBI) and to correlate such changes with clinical and neurocognitive metrics. MATERIALS AND METHODS This institutional review board-approved study was HIPAA compliant. Twenty-eight patients with MTBI (with 19 followed up at 1 year) with posttraumatic symptoms after injury and 22 matched control subjects (with 12 followed up at 1 year) were enrolled. Automated segmentation of brain regions to compute regional gray matter (GM) and white matter (WM) volumes was performed by using three-dimensional T1-weighted 3.0-T magnetic resonance imaging, and results were correlated with clinical metrics. Pearson and Spearman rank correlation coefficients were computed between longitudinal brain volume and neurocognitive scores, as well as clinical metrics, over the course of the follow-up period. RESULTS One year after MTBI, there was measurable global brain atrophy, larger than that in control subjects. The anterior cingulate WM bilaterally and the left cingulate gyrus isthmus WM, as well as the right precuneal GM, showed significant decreases in regional volume in patients with MTBI over the 1st year after injury (corrected P < .05); this was confirmed by means of cross-sectional comparison with data in control subjects (corrected P < .05). Left and right rostral anterior cingulum WM volume loss correlated with changes in neurocognitive measures of memory (r = 0.65, P = .005) and attention (r = 0.60, P = .01). At 1-year follow-up, WM volume in the left cingulate gyrus isthmus correlated with clinical scores of anxiety (Spearman rank correlation r = -0.68, P = .007) and postconcussive symptoms (Spearman rank correlation r = -0.65, P = .01). CONCLUSION These observations demonstrate structural changes to the brain 1 year after injury after a single concussive episode. Regional brain atrophy is not exclusive to moderate and severe traumatic brain injury but may be seen after mild injury. In particular, the anterior part of the cingulum and the cingulate gyrus isthmus, as well as the precuneal GM, may be distinctively vulnerable 1 year after MTBI.
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Affiliation(s)
- Yongxia Zhou
- Department of Radiology, New York University School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016, USA
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Zhou Y, Milham MP, Lui YW, Miles L, Reaume J, Sodickson DK, Grossman RI, Ge Y. Default-mode network disruption in mild traumatic brain injury. Radiology 2013; 265:882-92. [PMID: 23175546 DOI: 10.1148/radiol.12120748] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the integrity of the default-mode network (DMN) by using independent component analysis (ICA) methods in patients shortly after mild traumatic brain injury (MTBI) and healthy control subjects, and to correlate DMN connectivity changes with neurocognitive tests and clinical symptoms. MATERIALS AND METHODS This study was approved by the institutional review board and complied with HIPAA regulations. Twenty-three patients with MTBI who had posttraumatic symptoms shortly after injury (<2 months) and 18 age-matched healthy control subjects were included in this study. Resting-state functional magnetic resonance imaging was performed at 3 T to characterize the DMN by using ICA methods, including a single-participant ICA on the basis of a comprehensive template from core seeds in the posterior cingulate cortex (PCC) and medial prefrontal cortex (MPFC) nodes. ICA z images of DMN components were compared between the two groups and correlated with neurocognitive tests and clinical performance in patients by using Pearson and Spearman rank correlation. RESULTS When compared with the control subjects, there was significantly reduced connectivity in the PCC and parietal regions and increased frontal connectivity around the MPFC in patients with MTBI (P < .01). These frontoposterior opposing changes within the DMN were significantly correlated (r = -0.44, P = .03). The reduced posterior connectivity correlated positively with neurocognitive dysfunction (eg, cognitive flexibility), while the increased frontal connectivity correlated negatively with posttraumatic symptoms (ie, depression, anxiety, fatigue, and postconcussion syndrome). CONCLUSION These results showed abnormal DMN connectivity patterns in patients with MTBI, which may provide insight into how neuronal communication and information integration are disrupted among DMN key structures after mild head injury.
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Affiliation(s)
- Yongxia Zhou
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016, USA
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Bakas T, McLennon SM, Carpenter JS, Buelow JM, Otte JL, Hanna KM, Ellett ML, Hadler KA, Welch JL. Systematic review of health-related quality of life models. Health Qual Life Outcomes 2012; 10:134. [PMID: 23158687 PMCID: PMC3548743 DOI: 10.1186/1477-7525-10-134] [Citation(s) in RCA: 261] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 11/07/2012] [Indexed: 11/23/2022] Open
Abstract
Background A systematic literature review was conducted to (a) identify the most frequently used health-related quality of life (HRQOL) models and (b) critique those models. Methods Online search engines were queried using pre-determined inclusion and exclusion criteria. We reviewed titles, abstracts, and then full-text articles for their relevance to this review. Then the most commonly used models were identified, reviewed in tables, and critiqued using published criteria. Results Of 1,602 titles identified, 100 articles from 21 countries met the inclusion criteria. The most frequently used HRQOL models were: Wilson and Cleary (16%), Ferrans and colleagues (4%), or World Health Organization (WHO) (5%). Ferrans and colleagues’ model was a revision of Wilson and Cleary’s model and appeared to have the greatest potential to guide future HRQOL research and practice. Conclusions Recommendations are for researchers to use one of the three common HRQOL models unless there are compelling and clearly delineated reasons for creating new models. Disease-specific models can be derived from one of the three commonly used HRQOL models. We recommend Ferrans and colleagues’ model because they added individual and environmental characteristics to the popular Wilson and Cleary model to better explain HRQOL. Using a common HRQOL model across studies will promote a coherent body of evidence that will more quickly advance the science in the area of HRQOL.
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Affiliation(s)
- Tamilyn Bakas
- Indiana University School of Nursing, 1111 Middle Drive, Indianapolis, IN 46202, USA.
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Mild Traumatic Brain Injury: Are ED Providers Identifying Which Patients Are at Risk? J Emerg Nurs 2012; 38:435-42. [DOI: 10.1016/j.jen.2011.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/08/2011] [Accepted: 04/03/2011] [Indexed: 11/18/2022]
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Sveen U, Ostensjo S, Laxe S, Soberg HL. Problems in functioning after a mild traumatic brain injury within the ICF framework: the patient perspective using focus groups. Disabil Rehabil 2012; 35:749-57. [DOI: 10.3109/09638288.2012.707741] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jones KD, Young T, Leppma M. Mild Traumatic Brain Injury and Posttraumatic Stress Disorder in Returning Iraq and Afghanistan War Veterans: Implications for Assessment and Diagnosis. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2010.tb00036.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mild traumatic brain injury results in extensive neuronal degeneration in the cerebral cortex. J Neuropathol Exp Neurol 2011; 70:183-91. [PMID: 21293299 DOI: 10.1097/nen.0b013e31820c6878] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mild traumatic brain injury (mTBI) leads to long-term cognitive and emotional difficulties and behavioral disturbances, but the diagnosis and treatment of mTBI have historically been hampered by a lack of evidence-based correlates of these clinical manifestations. Unlike moderate and severe TBI, mTBI does not show significant tissue lesions or cavities in the cortex. Moreover, neuroimaging by magnetic resonance imaging or computed tomography is usually negative, suggesting that the damage is beyond the resolution of current structure-based scanning technologies. Therefore, we investigated the morphologies of spared neurons in the mouse cortex after mTBI in a controlled cortical impact injury model. Our results indicate that, although mTBI caused only a mild extent of cell death, it led to extensive dendrite degeneration and synapse reduction in the cortex in this model. This study sheds light on the neuropathologic consequences of mTBI in humans and suggests that neurodegeneration may be a novel target for developing diagnostic methods and therapeutic approaches for mTBI.
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Shukla D, Devi BI, Agrawal A. Outcome measures for traumatic brain injury. Clin Neurol Neurosurg 2011; 113:435-41. [PMID: 21440363 DOI: 10.1016/j.clineuro.2011.02.013] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 01/05/2011] [Accepted: 02/12/2011] [Indexed: 10/18/2022]
Abstract
Traumatic brain injury (TBI) is a major public health problem resulting in death and disabilities of young and productive people. Though the mortality of TBI has decreased substantially in recent years the disability due to TBI has not appreciably reduced. Various outcome scales have been proposed and used to assess disability after TBI. A few, commonly used are Glasgow Outcome Scale (GOS) with or without extended scores, Disability Rating Scale (DRS), Functional Independence Measure (FIM), Community Integration Questionnaire (CIQ), and the Functional Status Examination (FSE). These scales assess disability resulting from physical and cognitive impairments. For patients with good physical recovery a cognitive and neuropsychological outcome measure is required. Such measures include Neurobehavioural Function Inventory and specific neuropsychological tests like Rey Complex Figure for visuoconstruction and memory, Controlled Oral Word Association for verbal fluency, Symbol Digit Modalities (verbal) for sustained attention and Grooved Pegboard for fine motor dexterity. A more holistic and complete outcome measure is Quality of Life (QOL). Disease specific QOL measure for TBI, Quality of Life after Brain Injury (QOLIBRI) has also been recently proposed. The problems with outcome measures include poor operational definitions, lack of sensitivity or low ceiling effects, inability to evaluate patients who cannot report, lack of integration of morbidity and mortality categories, and limited domains of functioning assessed. GOSE-E satisfies most of the criteria of good outcome scale and in combination with neuropsychological tests is a near complete instrument for assessment of outcome after TBI.
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Affiliation(s)
- Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
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Caro DHJ. Towards systemic sustainable performance of TBI care systems: emergency leadership frontiers. Int J Emerg Med 2010; 3:357-65. [PMID: 21373305 PMCID: PMC3047861 DOI: 10.1007/s12245-010-0252-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 10/20/2010] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic brain injuries (TBIs) continue as a twenty-first century subterranean and almost invisible scourge internationally. TBI care systems provide a safety net for survival, recovery, and reintegration into social communities from this scourge, particularly in Canada, the European Union, and the USA. Aims This paper examines the underlying issues of systemic performance and sustainability of TBI care systems, in the light of decreasing care resources and increasing demands for services. Methods This paper reviews the extant literature on TBI care systems, systems reengineering, and emergency leadership literature. Results This paper presents a seven care layer paradigm, which forms the essence of systemic performance in the care of patients with TBIs. It also identifies five key strategic drivers that hold promise for the future systemic sustainability of TBI care systems. Conclusions Transformational leadership and engagement from the international emergency medical community is the key to generating positive change. The sustainability/performance care framework is relevant and pertinent for consideration internationally and in the context of other emergency medical populations.
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Affiliation(s)
- Denis H. J. Caro
- Telfer School of Management/École de Gestion Telfer, University of Ottawa/Université d’Ottawa, 5141 Desmarais Building, 55 Laurier East, Ottawa, ON K1N 6N5 Canada
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Wilson BA. Carrying out research into outcomes. Foreword. Neuropsychol Rehabil 2009; 19:785-9. [PMID: 19544184 DOI: 10.1080/09602010903021261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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de Leon MB, Kirsch NL, Maio RF, Tan-Schriner CU, Millis SR, Frederiksen S, Tanner CL, Breer ML. Baseline predictors of fatigue 1 year after mild head injury. Arch Phys Med Rehabil 2009; 90:956-65. [PMID: 19480871 DOI: 10.1016/j.apmr.2008.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 12/02/2008] [Accepted: 12/21/2008] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare reports of fatigue 12 months after minor trauma by participants with mild head injury (MHI) with those with other injury, and identify injury and baseline predictors of fatigue. DESIGN An inception cohort study of participants with MHI and other nonhead injuries recruited from and interviewed at the emergency department (ED), with a follow-up telephone interview at 12 months. SETTING Level II community hospital ED. PARTICIPANTS Participants (n=58) with MHI and loss of consciousness (LOC) of 30 minutes or less and/or posttraumatic amnesia (PTA) less than 24 hours, 173 with MHI but no PTA/LOC, and 128 with other mild nonhead injuries. INCLUSION CRITERIA age 18 years or older, within 24 hours of injury, Glasgow Coma Scale score of 13 or higher, and discharge from the ED. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Medical Outcomes Study 36-Item Short-Form Health Survey Vitality subscale. RESULTS Significant predictors of fatigue severity at 12 months were baseline fatigue, having seen a counselor for a mental health issue, medical disability, marital status, and in some stage of litigation. Injury type was not a significant predictor. CONCLUSIONS Fatigue severity 12 months after injury is associated with baseline characteristics and not MHI. Clinicians should be cautious about attributing persisting fatigue to MHI without comprehensive consideration of other possible etiologic factors.
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Affiliation(s)
- Marita B de Leon
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109-5742, USA
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A review of health-related quality of life in adult traumatic brain injury survivors in the context of combat veterans. J Neurosci Nurs 2009; 41:59-71. [PMID: 19361122 DOI: 10.1097/jnn.0b013e31819a7133] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health-related quality of life (HRQOL) research in traumatic brain injury (TBI) populations is beginning to emerge in the literature. Because rehabilitation and reintegration issues are complex with TBI, especially with new combat veterans, it is critical that future HRQOL research be designed to consider these issues. Utilizing explicit definitions and a conceptual model of HRQOL can provide researchers with a holistic base on which to build interventions for successful patient outcomes. The conceptual model of HRQOL of C.E. Ferrans, J.J. Zerwic, J.E. Wilbur, and J.L. Larson (2005) is an exemplar model that presents clear definitions and encompasses domains of HRQOL relevant to TBI survivors and their families. This review was organized utilizing the model of HRQOL of Ferrans et al. The objective of this review was to identify gaps in current knowledge of HRQOL and TBI. These findings were then used to develop recommendations for future research with combat veterans who have sustained a TBI.
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Bernabeu M, Laxe S, Lopez R, Stucki G, Ward A, Barnes M, Kostanjsek N, Reed G, Tate R, Whyte J, Zasler N, Cieza A. Developing core sets for persons with traumatic brain injury based on the international classification of functioning, disability, and health. Neurorehabil Neural Repair 2009; 23:464-7. [PMID: 19221004 DOI: 10.1177/1545968308328725] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors outline the process for developing the International Classification of Functioning, Disability, and Health (ICF) Core Sets for traumatic brain injury (TBI). ICF Core Sets are selections of categories of the ICF that identify relevant categories of patients affected by specific diseases. Comprehensive and brief ICF Core Sets for TBI should become useful for clinical practice and for research. The final definition of the ICF Core Sets for TBI will be determined at an ICF Core Sets Consensus Conference, which will integrate evidence from preliminary studies. The development of ICF Core Sets is an inclusive and open process and rehabilitation professionals are invited to participate.
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Affiliation(s)
- Montserrat Bernabeu
- Brain Injury Unit, Institut Guttmann, Neurorehabilitation Hospital, Barcelona, Spain
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