1
|
Orr TJ, Lesha E, Kramer AH, Cecia A, Dugan JE, Schwartz B, Einhaus SL. Traumatic Brain Injury: A Comprehensive Review of Biomechanics and Molecular Pathophysiology. World Neurosurg 2024; 185:74-88. [PMID: 38272305 DOI: 10.1016/j.wneu.2024.01.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
Traumatic brain injury (TBI) is a critical public health concern with profound consequences for affected individuals. This comprehensive literature review delves into TBI intricacies, encompassing primary injury biomechanics and the molecular pathophysiology of the secondary injury cascade. Primary TBI involves a complex interplay of forces, including impact loading, blast overpressure, and impulsive loading, leading to diverse injury patterns. These forces can be categorized into inertial (e.g., rotational acceleration causing focal and diffuse injuries) and contact forces (primarily causing focal injuries like skull fractures). Understanding their interactions is crucial for effective injury management. The secondary injury cascade in TBI comprises multifaceted molecular and cellular responses, including altered ion concentrations, dysfunctional neurotransmitter networks, oxidative stress, and cellular energy disturbances. These disruptions impair synaptic function, neurotransmission, and neuroplasticity, resulting in cognitive and behavioral deficits. Moreover, neuroinflammatory responses play a pivotal role in exacerbating damage. As we endeavor to bridge the knowledge gap between biomechanics and molecular pathophysiology, further research is imperative to unravel the nuanced interplay between mechanical forces and their consequences at the molecular and cellular levels, ultimately guiding the development of targeted therapeutic strategies to mitigate the debilitating effects of TBI. In this study, we aim to provide a concise review of the bridge between biomechanical processes causing primary injury and the ensuing molecular pathophysiology of secondary injury, while detailing the subsequent clinical course for this patient population. This knowledge is crucial for advancing our understanding of TBI and developing effective interventions to improve outcomes for those affected.
Collapse
Affiliation(s)
- Taylor J Orr
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Emal Lesha
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Semmes Murphey Clinic, Memphis, Tennessee
| | - Alexandra H Kramer
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Arba Cecia
- School of Medicine, Loyola University Chicago, Chicago, Illinois
| | - John E Dugan
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Barrett Schwartz
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Semmes Murphey Clinic, Memphis, Tennessee
| | - Stephanie L Einhaus
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Semmes Murphey Clinic, Memphis, Tennessee
| |
Collapse
|
2
|
Howe EI, Zeldovich M, Andelic N, von Steinbuechel N, Fure SCR, Borgen IMH, Forslund MV, Hellstrøm T, Søberg HL, Sveen U, Rasmussen M, Kleffelgaard I, Tverdal C, Helseth E, Løvstad M, Lu J, Arango-Lasprilla JC, Tenovuo O, Azouvi P, Dawes H, Roe C. Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study. BMC Health Serv Res 2022; 22:1536. [PMID: 36527074 PMCID: PMC9758851 DOI: 10.1186/s12913-022-08908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. METHODS Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale - Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury - Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. RESULTS Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. CONCLUSIONS Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. TRIAL REGISTRATION ClinicalTrials.gov NCT02210221.
Collapse
Affiliation(s)
- Emilie Isager Howe
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marina Zeldovich
- grid.411984.10000 0001 0482 5331Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Nada Andelic
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
| | - Nicole von Steinbuechel
- grid.411984.10000 0001 0482 5331Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Silje C. R. Fure
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
| | - Ida M. H. Borgen
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Marit V. Forslund
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Torgeir Hellstrøm
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Helene L. Søberg
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway ,grid.412414.60000 0000 9151 4445Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Unni Sveen
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway ,grid.412414.60000 0000 9151 4445Department for Occupational Therapy Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Mari Rasmussen
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Ingerid Kleffelgaard
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Cathrine Tverdal
- grid.55325.340000 0004 0389 8485Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- grid.55325.340000 0004 0389 8485Department of Neurosurgery, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Løvstad
- grid.5510.10000 0004 1936 8921Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway ,grid.416731.60000 0004 0612 1014Research Department, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
| | - Juan Lu
- grid.5510.10000 0004 1936 8921Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway ,grid.224260.00000 0004 0458 8737Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, USA
| | | | - Olli Tenovuo
- grid.410552.70000 0004 0628 215XTurku Brain Injury Centre, Turku University Hospital, Turku, Finland ,grid.1374.10000 0001 2097 1371Department of Clinical Neurosciences, University of Turku, Turku, Finland
| | - Philippe Azouvi
- grid.50550.350000 0001 2175 4109AP-HP, GH Paris-Saclay, Hospital Raymond Poincaré, Garches, France ,grid.7429.80000000121866389Université Paris-Saclay, UVSQ, Inserm, CESP, UMR 1018, Team DevPsy, Paris, France
| | - Helen Dawes
- grid.8391.30000 0004 1936 8024College of Medicine and Health, University of Exeter, Exeter, UK ,grid.451190.80000 0004 0573 576XOxford Health Biomedical Research Centre, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Cecilie Roe
- grid.55325.340000 0004 0389 8485Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway ,grid.5510.10000 0004 1936 8921Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | |
Collapse
|