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Conti F, McCue JJ, DiTuro P, Galpin AJ, Wood TR. Mitigating Traumatic Brain Injury: A Narrative Review of Supplementation and Dietary Protocols. Nutrients 2024; 16:2430. [PMID: 39125311 PMCID: PMC11314487 DOI: 10.3390/nu16152430] [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: 07/03/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Traumatic brain injuries (TBIs) constitute a significant public health issue and a major source of disability and death in the United States and worldwide. TBIs are strongly associated with high morbidity and mortality rates, resulting in a host of negative health outcomes and long-term complications and placing a heavy financial burden on healthcare systems. One promising avenue for the prevention and treatment of brain injuries is the design of TBI-specific supplementation and dietary protocols centred around nutraceuticals and biochemical compounds whose mechanisms of action have been shown to interfere with, and potentially alleviate, some of the neurophysiological processes triggered by TBI. For example, evidence suggests that creatine monohydrate and omega-3 fatty acids (DHA and EPA) help decrease inflammation, reduce neural damage and maintain adequate energy supply to the brain following injury. Similarly, melatonin supplementation may improve some of the sleep disturbances often experienced post-TBI. The scope of this narrative review is to summarise the available literature on the neuroprotective effects of selected nutrients in the context of TBI-related outcomes and provide an evidence-based overview of supplementation and dietary protocols that may be considered in individuals affected by-or at high risk for-concussion and more severe head traumas. Prophylactic and/or therapeutic compounds under investigation include creatine monohydrate, omega-3 fatty acids, BCAAs, riboflavin, choline, magnesium, berry anthocyanins, Boswellia serrata, enzogenol, N-Acetylcysteine and melatonin. Results from this analysis are also placed in the context of assessing and addressing important health-related and physiological parameters in the peri-impact period such as premorbid nutrient and metabolic health status, blood glucose regulation and thermoregulation following injury, caffeine consumption and sleep behaviours. As clinical evidence in this research field is rapidly emerging, a comprehensive approach including appropriate nutritional interventions has the potential to mitigate some of the physical, neurological, and emotional damage inflicted by TBIs, promote timely and effective recovery, and inform policymakers in the development of prevention strategies.
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Affiliation(s)
- Federica Conti
- School of Physics, University of Sydney, Sydney, NSW 2050, Australia;
| | - Jackson J. McCue
- School of Medicine, University of Washington, Seattle, WA 98195, USA;
| | - Paul DiTuro
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Andrew J. Galpin
- Center for Sport Performance, California State University, Fullerton, CA 92831, USA;
| | - Thomas R. Wood
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Institute for Human and Machine Cognition, Pensacola, FL 32502, USA
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Elliott JE, Brewer JS, Keil AT, Ligman BR, Bryant-Ekstrand MD, McBride AA, Powers K, Sicard SJ, Twamley EW, O’Neil ME, Hildebrand AD, Nguyen T, Morasco BJ, Gill JM, Dengler BA, Lim MM. Feasibility and acceptability for LION, a fully remote, randomized clinical trial within the VA for light therapy to improve sleep in Veterans with and without TBI: An MTBI 2 sponsored protocol. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.30.24308195. [PMID: 38853958 PMCID: PMC11160858 DOI: 10.1101/2024.05.30.24308195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Sleep-wake disturbances frequently present in Veterans with mild traumatic brain injury (mTBI). These TBI-related sleep impairments confer significant burden and commonly exacerbate other functional impairments. Therapies to improve sleep following mTBI are limited and studies in Veterans are even more scarce. In our previous pilot work, morning bright light therapy (MBLT) was found to be a feasible behavioral sleep intervention in Veterans with a history of mTBI; however, this was single-arm, open-label, and non-randomized, and therefore was not intended to establish efficacy. The present study, LION (light vs ion therapy) extends this preliminary work as a fully powered, sham-controlled, participant-masked randomized controlled trial (NCT03968874), implemented as fully remote within the VA (target n=120 complete). Randomization at 2:1 allocation ratio to: 1) active: MBLT (n=80), and 2) sham: deactivated negative ion generator (n=40); each with identical engagement parameters (60-min duration; within 2-hrs of waking; daily over 28-day duration). Participant masking via deception balanced expectancy assumptions across arms. Outcome measures were assessed following a 14-day baseline (pre-intervention), following 28-days of device engagement (post-intervention), and 28-days after the post-intervention assessment (follow-up). Primary outcomes were sleep measures, including continuous wrist-based actigraphy, self-report, and daily sleep dairy entries. Secondary/exploratory outcomes included cognition, mood, quality of life, circadian rhythm via dim light melatonin onset, and biofluid-based biomarkers. Participant drop out occurred in <10% of those enrolled, incomplete/missing data was present in <15% of key outcome variables, and overall fidelity adherence to the intervention was >85%, collectively establishing feasibility and acceptability for MBLT in Veterans with mTBI.
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Affiliation(s)
- Jonathan E. Elliott
- VA Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA
- Military Traumatic Brain Injury Initiative (MTBI), Bethesda, MD, USA
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Elizabeth W. Twamley
- VA San Diego Health Care System, Research Service; Center of Excellence for Stress and Mental Health, San Diego, CA, USA
- University of California San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Maya E. O’Neil
- VA Portland Health Care System, Portland, OR, USA
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Oregon Health & Science University, Medical Informatics and Clinical Epidemiology, Portland, OR, USA
- Oregon Health & Science University, Department of Psychiatry, Portland, OR, USA
| | - Andrea D. Hildebrand
- Oregon Health & Science University – Portland State University, School of Public Health, Biostatistics & Design Program, Portland, OR, USA
| | - Thuan Nguyen
- Oregon Health & Science University – Portland State University, School of Public Health, Biostatistics & Design Program, Portland, OR, USA
| | - Benjamin J. Morasco
- VA Portland Health Care System, Portland, OR, USA
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Oregon Health & Science University, Department of Psychiatry, Portland, OR, USA
| | - Jessica M. Gill
- John’s Hopkins University, School of Nursing, Baltimore, MD, USA
| | | | - Miranda M. Lim
- VA Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Department of Neurology, Portland, OR, USA
- Military Traumatic Brain Injury Initiative (MTBI), Bethesda, MD, USA
- VISN 20 Northwest Mental Illness Research, Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
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Gervais C, Hjeij D, Fernández-Puerta L, Arbour C. Non-pharmacological interventions for sleep disruptions and fatigue after traumatic brain injury: a scoping review. Brain Inj 2024; 38:403-416. [PMID: 38402580 DOI: 10.1080/02699052.2024.2318599] [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: 04/28/2022] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The aim of this study was to conduct a scoping review to determine the nature, variety, and volume of empirical evidence on nonpharmacological interventions for sleep disturbances with potential implications for fatigue in adults sustaining a traumatic brain injury (TBI). METHODS A systematic literature search was conducted across four databases to identify primary studies testing a single non-pharmacological intervention or a combination of non-pharmacological interventions for sleep disturbances and fatigue in community-dwelling adults with TBI. RESULTS Sixteen studies were reviewed addressing six non-pharmacological interventions for sleep disruptions and fatigue after TBI including light therapy, cognitive-behavioral therapy, warm footbath application, shiatsu, and sleep hygiene protocol. Non-pharmacological interventions involving light or cognitive-behavioral therapy were reported in 75% of the studies. Actigraphy-based estimation of total sleep time and subjective level of fatigue were frequent outcomes. CONCLUSION While this scoping review has utility in describing existing non-pharmacological approaches to manage sleep and fatigue after TBI, the findings suggest that interventions are often developed without considering TBI individuals' source of motivation and the need for support in self-administration. Future studies may achieve greater sustainability by considering the evolving needs of TBI patients and their families and the drivers and barriers that might influence non-pharmacological intervention use at home.
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Affiliation(s)
- Charles Gervais
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Danny Hjeij
- Faculty of Nursing, Université de Montréal, Montreal, Canada
| | | | - Caroline Arbour
- Faculty of Nursing, Université de Montréal, Montreal, Canada
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Kawata K, Rettke DJ, Thompson C, Mannix R, Bazarian JJ, Datta D. Effectiveness of biomedical interventions on the chronic stage of traumatic brain injury: a systematic review of randomized controlled trials. Front Neurol 2024; 15:1321239. [PMID: 38562423 PMCID: PMC10983769 DOI: 10.3389/fneur.2024.1321239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Traumatic brain injury (TBI), in any form and severity, can pose risks for developing chronic symptoms that can profoundly hinder patients' work/academic, social, and personal lives. In the past 3 decades, a multitude of pharmacological, stimulation, and exercise-based interventions have been proposed to ameliorate symptoms, memory impairment, mental fatigue, and/or sleep disturbances. However, most research is preliminary, thus limited influence on clinical practice. This review aims to systematically appraise the evidence derived from randomized controlled trials (RCT) regarding the effectiveness of pharmacological, stimulation, and exercise-based interventions in treating chronic symptoms due to TBI. Our search results indicate that despite the largest volume of literature, pharmacological interventions, especially using neurostimulant medications to treat physical, cognitive, and mental fatigue, as well as daytime sleepiness, have yielded inconsistent results, such that some studies found improvements in fatigue (e.g., Modafinil, Armodafinil) while others failed to yield the improvements after the intervention. Conversely, brain stimulation techniques (e.g., transcranial magnetic stimulation, blue light therapy) and exercise interventions were effective in ameliorating mental health symptoms and cognition. However, given that most RCTs are equipped with small sample sizes, more high-quality, larger-scale RCTs is needed.
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Affiliation(s)
- Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
- Program in Neuroscience, The College of Arts and Sciences, Indiana University, Bloomington, IN, United States
| | - Devin J. Rettke
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Christopher Thompson
- Department of Kinesiology, Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Jeffrey J. Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Dibyadyuti Datta
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
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Liu L, Yin P, Dong Y, Fan Q, Huai Y, Zhang S, Lv S, Wang X, Chen Y. Neurological mechanism and efficacy of acupuncture for breast cancer-related insomnia: a study protocol for randomized clinical trial. Front Neurol 2023; 14:1278564. [PMID: 38187141 PMCID: PMC10771825 DOI: 10.3389/fneur.2023.1278564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/04/2023] [Indexed: 01/09/2024] Open
Abstract
Background Breast cancer survivors (BCSs) are at a higher risk of developing insomnia. The negative effects of cancer-related insomnia (CRI) include depression, anxiety, fatigue, aggressive pain, impaired immune functioning, decreased quality of life, and even increased cancer mortality. Although preliminary progress has been made in the treatment of CRI with acupuncture, the evidence is insufficient and the neurological mechanism underlying the effect of acupuncture is still unclear. Methods The study employs a single-blinded, randomized, controlled trial design. A total of 80 participants will be randomly allocated in a 1:1 ratio to either the treatment group (n = 40) or the control group (n = 40). The former will receive acupuncture treatment, while the latter will receive sham acupuncture treatment. Both groups will receive 12 sessions over a 4-week period, three times per week (every other day), and each session will last for 30 min. Follow-up assessments will be conducted in week 8. The primary outcome will be the treatment response rate. Secondary outcomes include the change in Insomnia Severity Index (ISI), the treatment remission rate, actigraphy sleep assessment, Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Quality of Life Core Scale (QLQ-C30), the weekly usage of remedial drugs, and functional magnetic resonance imaging (fMRI) analysis. Data for the outcomes will be collected at week 0 (the baseline), week 1 (the intervention period), week 4 (the post-treatment period), and week 8 (the follow-up period). Discussion The objective of this study is to assess the efficacy of acupuncture for patients with CRI in comparison with sham acupuncture. Additionally, the research aims to explore the neuropathological mechanisms of CRI and provide the first evidence on the characteristics of acupuncture treatment using fMRI. We expect that the results of this study will provide valuable scientific evidence of acupuncture treatment for CRI.Clinical trial registration: Chinese Clinical Trial Registry, identifier ChiCTR2300070349: https://www.chictr.org.cn/showproj.html?proj=188677.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yuelai Chen
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Yu J, Xu FQ. Clinical efficacy and safety of Guipi decoction combined with escitalopram oxalate tablets in patients with depression. World J Clin Cases 2023; 11:7017-7025. [PMID: 37946779 PMCID: PMC10631412 DOI: 10.12998/wjcc.v11.i29.7017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/05/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Depression is a widespread mental health condition that requires effective treatment. In the treatment of depression, traditional Chinese medicine (TCM) offers obvious advantages, fewer adverse reactions, and a lower recurrence rate. AIM To evaluate the clinical benefits of Guipi decoction combined with escitalopram oxalate tablets for individuals with depression. METHODS In total, 80 patients diagnosed as having depression were enrolled in the study and divided into either an experimental group or a control group. All of the patients were orally administered escitalopram oxalate tablets. Additionally, the experimental group received Jiajian Guipi decoction and reduced Governor vessel fumigation over 4 wk. TCM syndrome scores, Hamilton depression rating scale (HAM-D) scores, self-rating depression scale (SDS) scores, and Pittsburgh sleep quality index scores were measured for the two groups and compared before and after the treatment. The two groups were monitored for any adverse reactions. RESULTS After 4 wk of treatment, both groups exhibited a significant reduction in TCM syndrome scores compared with their pre-treatment scores (P < 0.05). However, the experimental group exhibited significantly lower TCM syndrome scores than the control group (P < 0.05). Similarly, the post-treatment SDS and HAM-D-24 scores were significantly lower in both groups than the pre-treatment scores (P < 0.05), with the experimental group exhibiting lower scores than the control group (P < 0.05). The total treatment efficiency was significantly better in the experimental group (97.14%) than in the control group (77.78%) (P < 0.05). Furthermore, after 4 wk of treatment, the Pittsburgh sleep quality index scores for both groups were significantly lower than those before the treatment (P < 0.05), with the experimental group exhibiting lower scores than the control group (P < 0.05). The incidence of adverse reactions was significantly lower in the experimental group than in the control group (P < 0.05). CONCLUSION The combination of Guipi decoction and escitalopram oxalate tablets was found to be an effective and safe treatment for depression. This combination could reduce TCM syndrome scores, improve depressive symptoms, and enhance sleep quality.
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Affiliation(s)
- Jia Yu
- Psychiatry Department, Beijing Changping Hospital of Traditional and Western Medicine, Beijing 102206, China
| | - Feng-Quan Xu
- Department of Psychosomatic Medicine, Guang'anmen Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing 100053, China
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Sudhakaran P. Traumatic Brain Injury: Acupuncture Treatment. Med Acupunct 2023; 35:251-256. [PMID: 37900878 PMCID: PMC10606947 DOI: 10.1089/acu.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Traumatic brain injury (TBI) is a significant cause of morbidity and mortality worldwide. It is estimated that half of the people in the world will experience at least 1 episode of TBI during their lifetimes. While the primary injury to the brain parenchyma is usually irreversible, the secondary effects, which involve cellular dysfunction, derangement of blood flow, and blood-brain barrier changes in ionic flux and elevated levels of free radicals are potentially amenable to treatment. At present, there are no neuroprotective agents in mainstream medicine to interrupt these secondary processes and improve the patient's neurologic outcome. Acupuncture holds promise to fill this gap and scientific evidence to that effect is presented. Sports-related brain injury is discussed in detail.
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Kim S, Mortera MH, Wen PS, Thompson KL, Lundgren K, Reed WR, Sasson N, Towner Wright S, Vora A, Krishnan S, Joseph J, Heyn P, Chin BS. The Impact of Complementary and Integrative Medicine Following Traumatic Brain Injury: A Scoping Review. J Head Trauma Rehabil 2023; 38:E33-E43. [PMID: 35452024 DOI: 10.1097/htr.0000000000000778] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine the evidence levels, study characteristics, and outcomes of nonpharmacologic complementary and integrative medicine (CIM) interventions in rehabilitation for individuals with traumatic brain injury (TBI). DATA SOURCES MEDLINE (OvidSP), PubMed (NLM), EMBASE ( Embase.com ), CINAHL (EBSCO), PsycINFO (OvidSP), Cochrane Library (Wiley), and National Guidelines Clearinghouse databases were evaluated using PRISMA guidelines. The protocol was registered in INPLASY (protocol registration: INPLASY202160071). DATA EXTRACTION Quantitative studies published between 1992 and 2020 investigating the efficacy of CIM for individuals with TBI of any severity, age, and outcome were included. Special diets, herbal and dietary supplements, and counseling/psychological interventions were excluded, as were studies with mixed samples if TBI data could not be extracted. A 2-level review comprised title/abstract screening, followed by full-text assessment by 2 independent reviewers. DATA SYNTHESIS In total, 90 studies were included, with 57 001 patients in total. This total includes 2 retrospective studies with 17 475 and 37 045 patients. Of the 90 studies, 18 (20%) were randomized controlled trials (RCTs). The remainder included 20 quasi-experimental studies (2-group or 1-group pre/posttreatment comparison), 9 retrospective studies, 1 single-subject study design, 2 mixed-methods designs, and 40 case study/case reports. Guided by the American Academy of Neurology evidence levels, class II criteria were met by 61% of the RCTs. Included studies examined biofeedback/neurofeedback (40%), acupuncture (22%), yoga/tai chi (11%), meditation/mindfulness/relaxation (11%), and chiropractic/osteopathic manipulation (11%). The clinical outcomes evaluated across studies included physical impairments (62%), mental health (49%), cognitive impairments (39%), pain (31%), and activities of daily living/quality of life (28%). Additional descriptive statistics were summarized using narrative synthesis. Of the studies included for analyses, 97% reported overall positive benefits of CIM. CONCLUSION Rigorous and well experimentally designed studies (including RCTs) are needed to confirm the initial evidence supporting the use of CIM found in the existing literature.
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Affiliation(s)
- Sonya Kim
- Departments of Rehabilitation Medicine (Drs Kim and Sasson) and Neurology (Dr Kim), New York University Grossman School of Medicine, New York; Department of Occupational Therapy, New York University, NYU Steinhardt, New York (Dr Mortera); Department of Occupational Therapy, Byrdine F. Lewis College of Nursing & Health Professions, Georgia State University, Atlanta, Georgia (Dr Wen); Department of Physical Medicine and Rehabilitation (Dr Thompson), University of North Carolina at Chapel Hill (Ms Wright); Department of Communication Sciences and Disorders, University of North Carolina Greensboro (Dr Lundgren); School of Health Professions, Department of Physical Therapy, University of Alabama at Birmingham (Dr Reed); Veterans Affairs New York Harbor Health Care System, New York (Dr Sasson); Spaulding Rehabilitation Network, Harvard Medical School, Boston, Massachusetts (Drs Vora and Chin); Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Krishnan); Emory College of Arts and Sciences, Emory University, Atlanta, Georgia (Mr Joseph); Physical Medicine & Rehabilitation, University of Colorado at Denver, Anschutz Medical Campus (Dr Heyn); and College of Human Medicine, Michigan State University, Grand Rapids (Dr Chin)
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Sleep Disturbances Following Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Feasibility and preliminary efficacy for morning bright light therapy to improve sleep and plasma biomarkers in US Veterans with TBI. A prospective, open-label, single-arm trial. PLoS One 2022; 17:e0262955. [PMID: 35421086 PMCID: PMC9009710 DOI: 10.1371/journal.pone.0262955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
Mild traumatic brain injury (TBI) is associated with persistent sleep-wake dysfunction, including insomnia and circadian rhythm disruption, which can exacerbate functional outcomes including mood, pain, and quality of life. Present therapies to treat sleep-wake disturbances in those with TBI (e.g., cognitive behavioral therapy for insomnia) are limited by marginal efficacy, poor patient acceptability, and/or high patient/provider burden. Thus, this study aimed to assess the feasibility and preliminary efficacy of morning bright light therapy, to improve sleep in Veterans with TBI (NCT03578003). Thirty-three Veterans with history of TBI were prospectively enrolled in a single-arm, open-label intervention using a lightbox (~10,000 lux at the eye) for 60-minutes every morning for 4-weeks. Pre- and post-intervention outcomes included questionnaires related to sleep, mood, TBI, post-traumatic stress disorder (PTSD), and pain; wrist actigraphy as a proxy for objective sleep; and blood-based biomarkers related to TBI/sleep. The protocol was rated favorably by ~75% of participants, with adherence to the lightbox and actigraphy being ~87% and 97%, respectively. Post-intervention improvements were observed in self-reported symptoms related to insomnia, mood, and pain; actigraphy-derived measures of sleep; and blood-based biomarkers related to peripheral inflammatory balance. The severity of comorbid PTSD was a significant positive predictor of response to treatment. Morning bright light therapy is a feasible and acceptable intervention that shows preliminary efficacy to treat disrupted sleep in Veterans with TBI. A full-scale randomized, placebo-controlled study with longitudinal follow-up is warranted to assess the efficacy of morning bright light therapy to improve sleep, biomarkers, and other TBI related symptoms.
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Treating sleep disorders following traumatic brain injury in adults: time for renewed effort? Sleep Med Rev 2022; 63:101631. [DOI: 10.1016/j.smrv.2022.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022]
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Li N, Wang R, Ai X, Guo X, Liu J, Sun L, Zhang R. Effect of acupuncture treatment on cognitive impairment after traumatic brain injury in adults: A protocol for systematic review. Medicine (Baltimore) 2021; 100:e28451. [PMID: 34941200 PMCID: PMC8702273 DOI: 10.1097/md.0000000000028451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Acupuncture has been widely used to treat cognitive impairment after traumatic brain injury (TBI). But its efficiency has not been scientifically and methodically evaluated. The objective of this study is to evaluate the efficiency and safety of the acupuncture treatment for cognitive impairment after TBI in adults. METHODS This protocol of systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. We will conduct the literature searching in the following electronic databases: the Cochrane Library, MEDLINE, EMBASE, Web of Science, Springer, the Chinese Science Citation Database (CSCD), China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), Wanfang, and the Chinese Scientific Journal Database (VIP). The time limit for retrieving studies is from establishment to November 2021 for each database. All published randomized controlled trials related to this review will be included. Review Manager (V.5.3.5) will be implemented for the assessment of bias risk and data analyses. The selection of the studies, data abstraction, and validations will be performed independently by 2 researchers. RESULTS This review will assess the clinical efficacy and safety, as well as the acupoints characteristics of acupuncture on CI of TBI in adults. CONCLUSION This review will summarize the current evidence of acupuncture on CI of TBI outcomes and provide guidance for clinicians and patients to select acupuncture for CI of TBI in adults. TRAIL REGISTRATION NUMBER This protocol of systematic review has been registered on INPLASY website (No. INPLASY2021110113).
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Affiliation(s)
- Na Li
- School of Acupuncture-Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Acupuncture-Tuina, Shaanxi University of Traditional Chinese Medicine, Xi’an, Shaanxi, China
| | - Ruihui Wang
- School of Acupuncture-Tuina, Shaanxi University of Traditional Chinese Medicine, Xi’an, Shaanxi, China
| | - Xia Ai
- School of Acupuncture-Tuina, Shaanxi University of Traditional Chinese Medicine, Xi’an, Shaanxi, China
| | - Xinrong Guo
- School of Acupuncture-Tuina, Shaanxi University of Traditional Chinese Medicine, Xi’an, Shaanxi, China
| | - Juan Liu
- School of Acupuncture-Tuina, Shaanxi University of Traditional Chinese Medicine, Xi’an, Shaanxi, China
| | - Lei Sun
- School of Acupuncture-Tuina, Shaanxi University of Traditional Chinese Medicine, Xi’an, Shaanxi, China
| | - Rongchao Zhang
- School of Acupuncture-Tuina, Shaanxi University of Traditional Chinese Medicine, Xi’an, Shaanxi, China
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Wang C, Xu WL, Li GW, Fu C, Li JJ, Wang J, Chen XY, Liu Z, Chen YF. Impact of Acupuncture on Sleep and Comorbid Symptoms for Chronic Insomnia: A Randomized Clinical Trial. Nat Sci Sleep 2021; 13:1807-1822. [PMID: 34675728 PMCID: PMC8519353 DOI: 10.2147/nss.s326762] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the efficacy and safety of acupuncture at HT 7 (Shenmen) and KI 7 (Fuliu) on sleep and comorbid symptoms for chronic insomnia. METHODS AND DESIGN A randomized, single-blind, parallel and sham-controlled trial consisted of an acupuncture group (n = 41) and a sham acupuncture group (n = 41). Setting: a tertiary hospital of integrated Chinese and Western medicine. Participants: 82 subjects with chronic insomnia based on the International Classification of Sleep Disorders, Third Edition (ICSD-3). Interventions: a 10-session acupuncture treatment at bilateral HT 7 and KI 7 or sham acupoints with shallow needling was performed over 3 weeks. Measurements: the Pittsburgh sleep quality index (PSQI) and insomnia severity index (ISI) were evaluated at baseline, posttreatment, and at two follow-ups as the primary outcome measures. Polysomnography (PSG) on two consecutive nights, the Beck anxiety inventory (BAI), the Beck depression inventory (BDI) fatigue severity scale (FSS) and the Epworth sleepiness scale (ESS) were evaluated at baseline and posttreatment as the secondary outcome measures. RESULTS After the treatments, PSQI scores decreased by 5.04 in the acupuncture group and 2.92 in the sham acupuncture group. ISI scores decreased by 7.65 in the acupuncture group and 5.05 in the sham acupuncture group. The between-group differences in the primary outcome measures posttreatment were statistically significant. However, no differences were found between the two groups during the two follow-ups. Regarding the PSG data, there were significantly lower levels of sleep onset latency (SOL), a lower percentage of sleep stage N1 and a higher percentage of sleep stage N3 in the acupuncture group than in the sham acupuncture group. After treatment, there were lower levels of comorbid symptoms (BAI, BDI, FSS and ESS) in both groups. However, no significant differences were observed between the groups. CONCLUSION Acupuncture at HT 7 and KI 7 is an effective and safe nonpharmacologic intervention option for chronic insomnia. CLINICAL TRIAL REGISTRATION The study was registered at the Chinese Clinical Trial Registry, registration ID: ChiCTR1900023787, China.
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Affiliation(s)
- Cong Wang
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Wen-lin Xu
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Guan-wu Li
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Cong Fu
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jin-jin Li
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jing Wang
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xin-yu Chen
- Acupuncture and Tuina Academy, Beijing University of Chinese Medicine Dongfang College, Hebei, People’s Republic of China
| | - Zhen Liu
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yun-fei Chen
- Department of Acupuncture and Moxibustion, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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14
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The cerebral mechanism of acupuncture for chronic insomnia with gastrointestinal disorder: protocol for a randomized controlled trial. Trials 2021; 22:386. [PMID: 34098994 PMCID: PMC8186179 DOI: 10.1186/s13063-021-05332-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 05/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background Many patients with chronic insomnia disorder (CID) have gastrointestinal (GI) symptoms. First-line insomnia medications do not treat GI problems. Acupuncture has a comprehensive regulative action on both CID and GI disorder and is receiving increasing attention. Recent studies indicate that both CID and GI diseases may cause abnormal brain activity. However, the neurological mechanism underlying the effect of acupuncture on such diseases is still unclear. The aim of this study is to explore the pathological mechanisms of CID with GI discomfort, as well as the main response characteristics of acupuncture treatment from multiple perspectives using multimodal magnetic resonance imaging (MRI). Methods A total of 60 participants with CID and GI disorders will be randomly divided into two groups (real acupuncture group and sham acupuncture group; ratio of 1:1). Patients will receive 20 sessions (five sessions per week) of real acupuncture treatment or sham acupuncture treatment. The primary outcome is the aggregate score on the Pittsburgh Sleep Quality Index. Secondary outcomes are scores on the Gastrointestinal Symptom Rating Scale, Self-Rating Anxiety Scale, and Self-Rating Depression Scale. Multimodal MRI scans and clinical assessments will be performed both at baseline and post-treatment. Another 30 age-, sex-, and education-matched healthy subjects will be recruited as controls and will receive MRI scans and clinical evaluations. Discussion This study aims to provide scientific evidence for the mechanism of acupuncture in treating CID with GI disorder using multimodal MRI imaging data on brain structure, function, and metabolism. Trial registration Chinese Clinical Trial Registry, ChiCTR1800017092 (URL: http://www.chictr.org.cn/showproj.aspx?proj=27173). Registered on July 11, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05332-3.
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15
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Pilon L, Frankenmolen N, Bertens D. Treatments for sleep disturbances in individuals with acquired brain injury: A systematic review. Clin Rehabil 2021; 35:1518-1529. [PMID: 34013776 PMCID: PMC8524684 DOI: 10.1177/02692155211014827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To systematically review the evidence on the treatments of sleep disturbances in individuals with acquired brain injury. DATA SOURCES PubMed, Embase, Web of Science, and PsycINFO were searched from inception to January 2021. REVIEW METHOD Eligibility criteria were (1) participants with mild to severe acquired brain injury from traumatic brain injury and stroke (⩾three months post-injury), (2) individuals aged 16 years and older, (3) participants with self-reported sleep disturbances, (4) controlled group studies and single case (experimental) studies, and (5) interventions aimed at treatment of sleep disturbances. Two researchers independently identified relevant studies and assessed their study quality using the revised Cochrane assessment of bias tool (RoB 2.0) and the risk-of-bias in N-of-1 trials (RoBiNT) scale. RESULTS The search yielded 655 records; 11 studies met the inclusion criteria and were included, with a total of 227 participants (207 individuals with traumatic brain injury, 20 stroke patients). Two studies included pharmacological therapy, six studies examined the effects of cognitive behavioral therapy and three studies investigated alternative interventions such as acupuncture. CONCLUSION Although there was heterogeneity in the study quality of the included studies, their outcomes suggest that cognitive behavioral therapy is recommended as treatment of choice for improving sleep in individuals with acquired brain injury, especially for patients with mild to severe traumatic brain injury. Future research should examine the effects of cognitive behavioral therapy in more high-quality randomized controlled designs.
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Affiliation(s)
- Louise Pilon
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Nikita Frankenmolen
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Dirk Bertens
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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16
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Abstract
Sleep disturbances are common after traumatic brain injury of all levels of severity, interfere with acute and long-term recovery, and can persist for years after injury. There is increasing evidence of the importance of sleep in improving brain function and recovery. Noticing and addressing sleep disturbances are important aspects of nursing care, especially for the prevention or early recognition of delirium. Nonpharmacologic interventions can improve sleep. Teaching about the importance of sleep after traumatic brain injury, promoting sleep hygiene, and multidisciplinary approaches to addressing sleep problems and improving sleep are important for recovery from traumatic brain injury.
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Affiliation(s)
- Kris B Weymann
- VA Portland Health Care System, Portland, OR, USA; Oregon Health & Science University, School of Nursing, SN-6S, 3455 Southwest US Veterans Hospital Road, Portland, OR 97239, USA.
| | - Jennifer M Rourke
- VA Portland Health Care System, P2IESD, 3710 Southwest US Veterans Hospital Road, Portland, OR 97239, USA
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17
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Chen WJ, Livneh H, Hsu CH, Hu YT, Lai NS, Guo HR, Tsai TY. The Relationship of Acupuncture Use to the Endometriosis Risk in Females With Rheumatoid Arthritis: Real-World Evidence From Population-Based Health Claims. Front Med (Lausanne) 2021; 7:601606. [PMID: 33693010 PMCID: PMC7937701 DOI: 10.3389/fmed.2020.601606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/11/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives: Women affected by rheumatoid arthritis (RA) have a higher risk of endometriosis, an estrogen-dependent, chronic inflammatory disease. Though acupuncture has long been a safe and effective therapy for treating inflammatory conditions, it is unclear whether it could prevent the onset of endometriosis. This study aims to determine the effect of acupuncture on the subsequent risk of endometriosis in female RA patients. Methods: Between 1998 and 2010, female subjects with RA were recruited from a nationwide database (5,736 patients; age ≥20 years). Enrolled patients included 2,407 acupuncture users and 2,407 nonusers randomly selected using propensity scores. The occurrence of endometriosis was recorded through the end of 2012. Cox proportional hazards regression was used to estimate the adjusted hazard ratio (HR) associated with acupuncture use. Results: During the follow-up period, 35 acupuncture users and 94 non-users developed endometriosis, with incidence rates of 2.36 and 4.91 per 1,000 person-years, respectively. Acupuncture use was associated with a 55% lower endometriosis risk (adjusted HR, 0.45; 95% confidence interval, 0.31–0.65). Those who received high intensity acupuncture (≥15 packages) had the greatest benefit. Conclusions: Findings suggest that adding acupuncture to conventional therapy may decrease the subsequent endometriosis risk in female RA patients. Prospective randomized trials are recommended to further clarify whether the association revealed in this study supports a causal link.
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Affiliation(s)
- Wei-Jen Chen
- Department of Chinese Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan City, Taiwan
| | - Hanoch Livneh
- Rehabilitation Counseling Program, Portland State University, Portland, OR, United States
| | - Chien-Hui Hsu
- Department of Rehabilitation, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ying-To Hu
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Occupational Safety, Health, and Medicine Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Tzung-Yi Tsai
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan.,Department of Medical Research, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
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18
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Lowe A, Bailey M, O’Shaughnessy T, Macavei V. Treatment of sleep disturbance following stroke and traumatic brain injury: a systematic review of conservative interventions. Disabil Rehabil 2020; 44:2975-2987. [DOI: 10.1080/09638288.2020.1856948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Alex Lowe
- The Hillingdon Hospitals NHS Foundation Trust, Hillingdon Hospital, London, UK
| | - Mark Bailey
- NHS Grampian, Woodend Hospital, Aberdeen, UK
| | | | - Vladimir Macavei
- Barts Health NHS Trust, Newham University Hospital, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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19
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Juan YH, Livneh H, Huang HJ, Lu MC, Yeh CC, Tsai TY. Decreased Risk of Dementia Among Patients With Traumatic Brain Injury Receiving Acupuncture Treatment: A Population-Based Retrospective Cohort Study. J Head Trauma Rehabil 2020; 34:E17-E23. [PMID: 30829815 DOI: 10.1097/htr.0000000000000464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We conducted a longitudinal cohort study comparing the effect of acupuncture on the risk of dementia in Taiwanese individuals with traumatic brain injury (TBI). DESIGN AND PARTICIPANTS A national health insurance database was used to identify 15 440 newly diagnosed TBI patients 20 to 70 years old between 1998 and 2007. Of the identified patients, 6308 received acupuncture following the onset of TBI (acupuncture users) and 9132 patients did not receive acupuncture (nonacupuncture users). MEASURES All enrollees were followed until the end of 2012 to record incident cases of dementia. A Cox proportional hazards regression model was used to compute adjusted hazard ratios for the relationship of acupuncture use with dementia. RESULTS During the follow-up period, 249 acupuncture users and 810 nonacupuncture users developed dementia, corresponding to incidence rates of 6.11 and 9.64 per 1000 person-years, respectively. Use of acupuncture was significantly associated with a lower risk of dementia. Those who received more than 5 sessions of acupuncture benefited most from it. CONCLUSIONS Adding acupuncture to the clinical management of patients with TBI may benefit these patients by decreasing their risk of developing dementia.
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Affiliation(s)
- Ying-Hsu Juan
- Department of Chinese Medicine (Drs Juan and Yeh), Department of Nursing (Ms Huang), Division of Allergy, Immunology and Rheumatology (Dr Lu), and Department of Research (Dr Tsai), Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Dalin Township, Chiayi, Taiwan; Graduate Institute of Integrated Medicine, College of Chinese Medicine (Dr Juan), and School of Chinese Medicine (Dr Yeh), China Medical University, Taichung, Taiwan; Rehabilitation Counseling Program, Portland State University, Portland, Oregon (Dr Livneh); Schools of Medicine (Dr Lu) and Post-Baccalaureate Chinese Medicine (Dr Yeh), Tzu Chi University, Hualien, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (Dr Tsai); and Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan (Dr Tsai)
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20
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Ford ME, Groet E, Daams JG, Geurtsen GJ, Van Bennekom CA, Van Someren EJ. Non-pharmacological treatment for insomnia following acquired brain injury: A systematic review. Sleep Med Rev 2020; 50:101255. [DOI: 10.1016/j.smrv.2019.101255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/19/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
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21
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Wadhawan A, Stiller JW, Potocki E, Okusaga O, Dagdag A, Lowry CA, Benros ME, Postolache TT. Traumatic Brain Injury and Suicidal Behavior: A Review. J Alzheimers Dis 2019; 68:1339-1370. [DOI: 10.3233/jad-181055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Abhishek Wadhawan
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Psychiatry Residency Training Program, Washington, DC, USA
| | - John W. Stiller
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Saint Elizabeths Hospital, Neurology Consultation Service, Washington, DC, USA
- Maryland State Athletic Commission, Baltimore, MD, USA
| | - Eileen Potocki
- VA Maryland Healthcare System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Olaoluwa Okusaga
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Aline Dagdag
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, MD, USA
| | - Christopher A. Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
- Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
| | - Michael E. Benros
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Teodor T. Postolache
- Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA
- Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD, USA
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22
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Abstract
BACKGROUND Sleep disorders play a significant role in the care of those with Traumatic Brain Injury (TBI). OBJECTIVE To provide a literature review on the interaction of sleep and circadian processes on those with TBI. METHODS A literature review was conducted on PubMed using the following key words and their combination: "Sleep Apnea", "Traumatic Brain Injury", "Circadian", "Parasomnia", "Insomnia", "Hypersomnia", "Narcolepsy", and "Restless Legs". We review the spectrum of traumatic brain injury associated sleep disorders and discuss clinical approaches to diagnosis and treatment. RESULTS Disordered sleep and wakefulness after TBI is common. Sleep disruption contributes to morbidity, such as the development of neurocognitive and neurobehavioral deficits, and prolongs the recovery phase after injury. Early recognition and correction of these problems may limit the secondary effects of traumatic brain injury and improve neuro recovery/patient outcomes. CONCLUSIONS A more focused approach to sleep health is appropriate when caring for those with TBI.
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Affiliation(s)
- Lisa F Wolfe
- Division of Pulmonary and Critical Care Medicine Northwestern University, Chicago, IL, USA
| | - Ashima S Sahni
- Division of Pulmonary and Critical Care Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Hrayr Attarian
- Department of Neurology Northwestern University, Chicago, IL, USA
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23
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Aoun R, Rawal H, Attarian H, Sahni A. Impact of traumatic brain injury on sleep: an overview. Nat Sci Sleep 2019; 11:131-140. [PMID: 31692507 PMCID: PMC6707934 DOI: 10.2147/nss.s182158] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/07/2019] [Indexed: 12/21/2022] Open
Abstract
Traumatic brain injury (TBI) is a global health problem that affects millions of civilians, athletes, and military personnel yearly. Sleeping disorders are one of the underrecognized sequalae even though they affect 46% of individuals with TBI. After a mild TBI, 29% of patients have insomnia, 25% have sleep apnea, 28% have hypersomnia, and 4% have narcolepsy. The type of sleep disturbance may also vary according to the number of TBIs sustained. Diffuse axonal injury within the sleep regulation system, disruption of hormones involved in sleep, and insults to the hypothalamus, brain stem, and reticular activating system are some of the proposed theories for the pathophysiology of sleep disorders after TBI. Genetic and anatomical factors also come to play in the development and severity of these sleeping disorders. Untreated sleep disturbances following TBI can lead to serious consequences with respect to an individual's cognitive functioning. Initial management focuses on conservative measures with progression to more aggressive options if necessary. Future research should attempt to establish the effectiveness of the treatments currently used, as well as identify manageable co-existing factors that could be exacerbating sleep disorders.
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Affiliation(s)
- Raissa Aoun
- Department of Neurology, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Himanshu Rawal
- Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD, USA
| | - Hrayr Attarian
- Department of Neurology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Ashima Sahni
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, IL, Chicago, USA
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24
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Merritt BP, Kretzmer T, McKenzie-Hartman TL, Gootam P. Neurobehavioral Management of the Polytrauma Veteran. Phys Med Rehabil Clin N Am 2018; 30:133-154. [PMID: 30470418 DOI: 10.1016/j.pmr.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Since the inception of the Afghanistan and Iraq wars, an increasing number of veterans have sought treatment from the Department of Veterans Affairs for combat-related injuries. Many veterans experience postconcussive symptoms, traumatic stress, chronic pain, sensory deficits, and/or headaches. The goal of this article was to highlight some of the challenges treatment providers may face, while providing rehabilitation specialists with important evaluation and treatment considerations in working with this population to maximize outcomes for these veterans.
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Affiliation(s)
- Bryan P Merritt
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Department of Neurology, University of South Florida Medical School, 4202 E Fowler Avenue, Tampa, FL 33620, USA.
| | - Tracy Kretzmer
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Department of Psychology, University of South Florida Medical School, 4202 E Fowler Avenue, Tampa, FL 33620, USA
| | - Tamara L McKenzie-Hartman
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Defense and Veterans Brain Injury Center (DVBIC), Silver Spring, MD, USA
| | - Praveen Gootam
- James A. Haley Veterans Hospital, 13000 Bruce B Downs Boulevard #117, Tampa, FL 33612, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida Medical School, 4202 E Fowler Avenue, Tampa, FL 33620, USA
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25
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Thomas A, Greenwald BD. Nonpharmacological management of sleep disturbances after traumatic brain injury. NeuroRehabilitation 2018; 43:355-360. [DOI: 10.3233/nre-182535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alphonsa Thomas
- JFK Medical Center-Johnson Rehabilitation Institute, Edison, NJ, USA
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26
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Driver S, Stork R. Pharmacological management of sleep after traumatic brain injury. NeuroRehabilitation 2018; 43:347-353. [DOI: 10.3233/nre-182536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Sangeeta Driver
- Brain Injury Medicine and Rehabilitation Program, Shirley Ryan Abilitylab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ryan Stork
- Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
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27
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Abstract
BACKGROUND Sleep disturbance plays a significant role in cognitive impairment following traumatic brain injury (TBI). OBJECTIVES To summarize recent findings that examine sleep disturbance and cognition in TBI. METHODS Epidemiological information on sleep disorders in people with TBI is presented. A simple introduction to the role of sleep in normal cognition provides context for the literature on clinical populations. Current theory on the mechanisms underlying cognitive problems in people with sleep disorder is briefly described. Findings on the relationship between sleep disorder and cognitive problems in TBI is examined in more detail. RESULTS Consistent reports of an association between sleep duration and cognition include several studies noting positive associations (shorter sleep duration accompanies cognitive impairment) and others observing negative associations (longer sleep duration accompanies cognitive problems). Both insomnia and hypersomnolence are forms of sleep disturbance that disrupt key mental processes such as memory consolidation. Obstructive sleep apnea, cerebral structural abnormalities, neurochemical changes and psychiatric pathology are implicated. CONCLUSIONS Additional information is needed on how severity of injury impacts sleep and cognition. Hypothesized mechanisms underlying the effects of sleep on cognition in TBI should be empirically tested. Further, discrepancies between objective and subjective measures of sleep and cognition must be explored.
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Affiliation(s)
- Eric B Larson
- Marianjoy Rehabilitation Hospital, 26W171 Roosevelt Road, Wheaton, IL 60187, USA. Tel.: +1 630 909 8608; Fax: +1 630 909 6572; E-mail:
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28
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Morse AM, Garner DR. Traumatic Brain Injury, Sleep Disorders, and Psychiatric Disorders: An Underrecognized Relationship. Med Sci (Basel) 2018; 6:E15. [PMID: 29462866 PMCID: PMC5872172 DOI: 10.3390/medsci6010015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 12/28/2022] Open
Abstract
Traumatic brain injury (TBI) is commonplace among pediatric patients and has a complex, but intimate relationship with psychiatric disease and disordered sleep. Understanding the factors that influence the risk for the development of TBI in pediatrics is a critical component of beginning to address the consequences of TBI. Features that may increase risk for experiencing TBI sometimes overlap with factors that influence the development of post-concussive syndrome (PCS) and recovery course. Post-concussive syndrome includes physical, psychological, cognitive and sleep-wake dysfunction. The comorbid presence of sleep-wake dysfunction and psychiatric symptoms can lead to a more protracted recovery and deleterious outcomes. Therefore, a multidisciplinary evaluation following TBI is necessary. Treatment is generally symptom specific and mainly based on adult studies. Further research is necessary to enhance diagnostic and therapeutic approaches, as well as improve the understanding of contributing pathophysiology for the shared development of psychiatric disease and sleep-wake dysfunction following TBI.
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Affiliation(s)
- Anne M Morse
- Janet Weis Children's Hospital, Department of Pediatric Neurology and Sleep Medicine, Geisinger Medical Center, MC 14-12, 100 N Academy Blvd, Danville, PA 17822, USA.
| | - David R Garner
- Department of Pediatrics, Geisinger Medical Center, Danville, PA 17822, USA.
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29
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Lucke-Wold BP, Logsdon AF, Nguyen L, Eltanahay A, Turner RC, Bonasso P, Knotts C, Moeck A, Maroon JC, Bailes JE, Rosen CL. Supplements, nutrition, and alternative therapies for the treatment of traumatic brain injury. Nutr Neurosci 2018; 21:79-91. [PMID: 27705610 PMCID: PMC5491366 DOI: 10.1080/1028415x.2016.1236174] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Studies using traditional treatment strategies for mild traumatic brain injury (TBI) have produced limited clinical success. Interest in treatment for mild TBI is at an all time high due to its association with the development of chronic traumatic encephalopathy and other neurodegenerative diseases, yet therapeutic options remain limited. Traditional pharmaceutical interventions have failed to transition to the clinic for the treatment of mild TBI. As such, many pre-clinical studies are now implementing non-pharmaceutical therapies for TBI. These studies have demonstrated promise, particularly those that modulate secondary injury cascades activated after injury. Because no TBI therapy has been discovered for mild injury, researchers now look to pharmaceutical supplementation in an attempt to foster success in human clinical trials. Non-traditional therapies, such as acupuncture and even music therapy are being considered to combat the neuropsychiatric symptoms of TBI. In this review, we highlight alternative approaches that have been studied in clinical and pre-clinical studies of TBI, and other related forms of neural injury. The purpose of this review is to stimulate further investigation into novel and innovative approaches that can be used to treat the mechanisms and symptoms of mild TBI.
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Affiliation(s)
- Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Aric F. Logsdon
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Linda Nguyen
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Ahmed Eltanahay
- Department of Neurosurgery, Oregon Health Sciences University, Portland, USA
| | - Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Patrick Bonasso
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, USA
| | - Chelsea Knotts
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Adam Moeck
- Department of Surgery, Matigan Army Medical Center, Tacoma, WA, USA
| | - Joseph C. Maroon
- Department of Neurosurgery, University of Pittsburgh Medical Center, PA, USA
| | - Julian E. Bailes
- Department of Neurosurgery, Northshore Healthcare System, Evanston, IL, USA
| | - Charles L. Rosen
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
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Sandsmark DK, Elliott JE, Lim MM. Sleep-Wake Disturbances After Traumatic Brain Injury: Synthesis of Human and Animal Studies. Sleep 2017; 40:3074241. [PMID: 28329120 PMCID: PMC6251652 DOI: 10.1093/sleep/zsx044] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 12/23/2022] Open
Abstract
Sleep-wake disturbances following traumatic brain injury (TBI) are increasingly recognized as a serious consequence following injury and as a barrier to recovery. Injury-induced sleep-wake disturbances can persist for years, often impairing quality of life. Recently, there has been a nearly exponential increase in the number of primary research articles published on the pathophysiology and mechanisms underlying sleep-wake disturbances after TBI, both in animal models and in humans, including in the pediatric population. In this review, we summarize over 200 articles on the topic, most of which were identified objectively using reproducible online search terms in PubMed. Although these studies differ in terms of methodology and detailed outcomes; overall, recent research describes a common phenotype of excessive daytime sleepiness, nighttime sleep fragmentation, insomnia, and electroencephalography spectral changes after TBI. Given the heterogeneity of the human disease phenotype, rigorous translation of animal models to the human condition is critical to our understanding of the mechanisms and of the temporal course of sleep-wake disturbances after injury. Arguably, this is most effectively accomplished when animal and human studies are performed by the same or collaborating research programs. Given the number of symptoms associated with TBI that are intimately related to, or directly stem from sleep dysfunction, sleep-wake disorders represent an important area in which mechanistic-based therapies may substantially impact recovery after TBI.
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Affiliation(s)
| | - Jonathan E Elliott
- VA Portland Health Care System, Portland, OR
- Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Miranda M Lim
- VA Portland Health Care System, Portland, OR
- Department of Neurology, Oregon Health & Science University, Portland, OR
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR; Department of Behavioral Neuroscience, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR
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Biajar A, Mollayeva T, Sokoloff S, Colantonio A. Assistive technology to enable sleep function in patients with acquired brain injury: Issues and opportunities. Br J Occup Ther 2017. [DOI: 10.1177/0308022616688017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Sleep disorders in patients with acquired brain injury are highly burdensome and associated with disability. An assistive technology framework emphasises the need to develop and apply a broad range of devices, strategies, and practices to ameliorate disabilities. We aimed to summarise scientific evidence regarding the utility of assistive technology in managing sleep disorders in patients with various causes of acquired brain injury. Method We retrieved articles before January 2016, through database searches of Medline, Embase, PsycINFO, CINAHL, and various bibliographies. The person–environment–occupation framework was used to analyse complex data pertaining to technology application and utility. Results We found 21 studies that described seven assistive technologies (continuous positive airway pressure, adaptive servo ventilator, nasotracheal suction mechanical ventilation, positioning devices, cognitive behavioural therapy, light therapy, and acupuncture) utilised in patients with acquired brain injury to manage sleep disorders. Conclusion Assistive technologies demonstrated effectiveness in alleviating and/or managing sleep disorders after acquired brain injury. Adherence to using the technology is limited by the level of injury-induced cognitive and physical impairment, technological regime, and environmental support. Development of user-friendly sleep-assistive technologies that take into consideration functional limitations and practice guidelines on structural communication between the occupational therapist, patient, and caregiver may facilitate patients’ self-determination in managing sleep disorders.
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Affiliation(s)
- Anmol Biajar
- Research placement student, Toronto Rehabilitation Institute – University Health Network, University of Toronto Mississauga, Canada
| | - Tatyana Mollayeva
- Postdoctoral fellow, Faculty of Occupational Sciences and Occupational Therapy, Faculty of Medicine University of Toronto, Canada
| | - Sandra Sokoloff
- Assistant to the Chair, Department of Occupational Science and Occupational Therapy Faculty of Medicine, University of Toronto, Canada
| | - Angela Colantonio
- Director, Rehabilitation Sciences Institute, University of Toronto Canada
- Professor, Occupational Sciences and Occupational Therapy, University of Toronto Canada
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Bell AE, Falconi A. Acupuncture for the Treatment of Sports Injuries in an Austere Environment. Curr Sports Med Rep 2016; 15:111-5. [DOI: 10.1249/jsr.0000000000000240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%-70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury. In addition, depression, anxiety, and pain are common brain injury comorbidities with significant influence on sleep quality. Two types of traumatic brain injury that may negatively impact sleep are acceleration/deceleration injuries causing generalized brain damage and contact injuries causing focal brain damage. Polysomnography, multiple sleep latency testing, and/or actigraphy may be utilized to diagnose sleep disorders after a head injury. Depending on the disorder, treatment may include the use of medications, positive airway pressure, and/or behavioral modifications. Unfortunately, the treatment of sleep disorders associated with traumatic brain injury may not improve neuropsychological function or sleepiness.
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Affiliation(s)
- Mari Viola-Saltzman
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Camelia Musleh
- Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA
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Hernández TD, Brenner LA, Walter KH, Bormann JE, Johansson B. Complementary and alternative medicine (CAM) following traumatic brain injury (TBI): Opportunities and challenges. Brain Res 2016; 1640:139-151. [PMID: 26806403 DOI: 10.1016/j.brainres.2016.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 11/15/2022]
Abstract
Traumatic brain injury (TBI) is highly prevalent and occurs in a variety of populations. Because of the complexity of its sequelae, treatment strategies pose a challenge. Given this complexity, TBI provides a unique target of opportunity for complementary and alternative medicine (CAM) treatments. The present review describes and discusses current opportunitites and challenges associated with CAM research and clinical applications in civilian, veteran and military service populations. In addition to a brief overview of CAM, the translational capacity from basic to clinical research to clinical practice will be described. Finally, a systematic approach to developing an adoptable evidence base, with proof of effectiveness based on the literature will be discussed. Inherent in this discussion will be the methodological and ethical challenges associated with CAM research in those with TBI and associated comorbidities, specifically in terms of how these challenges relate to practice and policy issues, implementation and dissemination. This article is part of a Special Issue entitled SI:Brain injury and recovery.
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Affiliation(s)
- Theresa D Hernández
- Department of Psychology and Neuroscience, University of Colorado at Boulder, United States; Center for Neuroscience, University of Colorado at Boulder, United States; Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), United States.
| | - Lisa A Brenner
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, United States; Department of Neurology, University of Colorado Anschutz Medical Campus, United States
| | | | - Jill E Bormann
- Department of Veteran Affairs, San Diego Healthcare System, Center of Excellence for Stress and Mental Health (CESAMH) and University of San Diego Hahn School of Nursing and Health Sciences/Beyster Institute of Nursing Research, United States
| | - Birgitta Johansson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden
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Ouellet MC, Beaulieu-Bonneau S, Morin CM. Sleep-wake disturbances after traumatic brain injury. Lancet Neurol 2015; 14:746-57. [PMID: 26067127 DOI: 10.1016/s1474-4422(15)00068-x] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 12/15/2022]
Abstract
Sleep-wake disturbances are extremely common after a traumatic brain injury (TBI). The most common disturbances are insomnia (difficulties falling or staying asleep), increased sleep need, and excessive daytime sleepiness that can be due to the TBI or other sleep disorders associated with TBI, such as sleep-related breathing disorder or post-traumatic hypersomnia. Sleep-wake disturbances can have a major effect on functional outcomes and on the recovery process after TBI. These negative effects can exacerbate other common sequelae of TBI-such as fatigue, pain, cognitive impairments, and psychological disorders (eg, depression and anxiety). Sleep-wake disturbances associated with TBI warrant treatment. Although evidence specific to patients with TBI is still scarce, cognitive-behavioural therapy and medication could prove helpful to alleviate sleep-wake disturbances in patients with a TBI.
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Affiliation(s)
- Marie-Christine Ouellet
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, QC, Canada; École de Psychologie, Université Laval, Québec, QC, Canada.
| | - Simon Beaulieu-Bonneau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, QC, Canada; École de Psychologie, Université Laval, Québec, QC, Canada; Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
| | - Charles M Morin
- École de Psychologie, Université Laval, Québec, QC, Canada; Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
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Zhang YM, Dai QF, Chen WH, Jiang ST, Chen SX, Zhang YJ, Tang CZ, Cheng SB. Effects of acupuncture on cortical expression of Wnt3a, β-catenin and Sox2 in a rat model of traumatic brain injury. Acupunct Med 2015; 34:48-54. [PMID: 26296359 DOI: 10.1136/acupmed-2014-010742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To observe the effects of acupuncture treatment on the expression of Wnt/β-catenin signalling pathway-related genes (Wnt3a, β-catenin and Sox2) in the injured cerebral cortex of rats with traumatic brain injury (TBI). METHODS A controlled impact model of TBI was established using Feeney's free-drop method. Seventy-eight Sprague-Dawley rats were randomly divided into the following three groups: a normal group (n=18) that was left untreated; a model group (n=30) that received no treatment after TBI; and an acupuncture group (n=30) that received acupuncture (at LI4, GV20, GV26 and GV16) after TBI. Rats in each group were randomly and equally divided into 3-day, 7-day and 14-day subgroups according to the duration of therapy. Real-time fluorescence quantitative PCR (RT-qPCR) was used to measure mRNA expression of Wnt3a, β-catenin and Sox2. Western blots were performed to determine the expression levels of WNT3a, β-Catenin and SOX2. RESULTS Wnt3a mRNA was upregulated in the 7-day and 14-day acupuncture subgroups compared with the corresponding model subgroups (p<0.05). β-catenin expression was significantly increased in the 7-day and 14-day acupuncture subgroups compared with the corresponding model subgroups (p<0.01). In the 3-day and 7-day acupuncture subgroups, Sox2 expression was significantly higher than that in the normal and model groups (p<0.01 each). The levels of WNT3a, β-catenin and SOX2 were generally consistent with the corresponding mRNA levels. CONCLUSIONS Acupuncture exerts a regulatory effect on the Wnt/β-catenin signalling pathway, which may in turn influence the proliferation and differentiation of endogenous neural stem cells.
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Affiliation(s)
- Yi-min Zhang
- Traditional Chinese Medicine Department, Medical College, Jinan University, Guangzhou, China
| | - Qiu-fu Dai
- Traditional Chinese Medicine Department, Medical College, Jinan University, Guangzhou, China
| | - Wei-hao Chen
- Traditional Chinese Medicine Department, Medical College, Jinan University, Guangzhou, China
| | - Shu-ting Jiang
- Traditional Chinese Medicine Department, Medical College, Jinan University, Guangzhou, China
| | - Sheng-xin Chen
- Traditional Chinese Medicine Department, Medical College, Jinan University, Guangzhou, China
| | - Yu-juan Zhang
- Traditional Chinese Medicine Department, Medical College, Jinan University, Guangzhou, China
| | - Chun-zhi Tang
- Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Shao-bing Cheng
- Traditional Chinese Medicine Department, Medical College, Jinan University, Guangzhou, China
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Purohit MP, Zafonte RD, Sherman LM, Davis RB, Giwerc MY, Shenton ME, Yeh GY. Neuropsychiatric symptoms and expenditure on complementary and alternative medicine. J Clin Psychiatry 2015; 76:e870-6. [PMID: 26231014 PMCID: PMC4729567 DOI: 10.4088/jcp.13m08682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/14/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms affect 37% of US adults. These symptoms are often refractory to standard therapies, and patients may consequently opt for complementary and alternative medicine therapies (CAM). We sought to determine the demand for CAM by those with neuropsychiatric symptoms compared to those without neuropsychiatric symptoms as measured by out-of-pocket expenditure. METHOD We compared CAM expenditure between US adults with and without neuropsychiatric symptoms (n = 23,393) using the 2007 National Health Interview Survey. Symptoms included depression, anxiety, insomnia, attention deficits, headaches, excessive sleepiness, and memory loss. CAM was defined per guidelines from the National Institutes of Health as mind-body therapies, biological therapies, manipulation therapies, or alternative medical systems. Expenditure on CAM by those without neuropsychiatric symptoms was compared to those with neuropsychiatric symptoms. RESULTS Of the adults surveyed, 37% had ≥ 1 neuropsychiatric symptom and spent $14.8 billion out-of-pocket on CAM. Those with ≥ 1 neuropsychiatric symptom were more likely than those without neuropsychiatric symptoms to spend on CAM (27.4% vs 20.3%, P < .001). Likelihood to spend on CAM increased with number of symptoms (27.2% with ≥ 3 symptoms, P < .001). After adjustment was made for confounders using logistic regression, those with ≥ 1 neuropsychiatric symptom remained more likely to spend on CAM (odds ratio [OR] = 1.34; 95% CI, 1.22-1.48), and the likelihood increased to 1.55 (95% CI, 1.34-1.79) for ≥ 3 symptoms. Anxiety (OR = 1.40 [95% CI, 1.22-1.60]) and excessive sleepiness (OR = 1.36 [95% CI, 1.21-1.54]) were the most closely associated with CAM expenditure. CONCLUSIONS Those with ≥ 1 neuropsychiatric symptom had disproportionately higher demand for CAM than those without symptoms. Research regarding safety, efficacy, and cost-effectiveness of CAM is limited; therefore, future research should evaluate these issues given the tremendous demand for these treatments.
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Affiliation(s)
- Maulik P Purohit
- Spaulding Rehabilitation Hospital Network, 300 First Ave, Charlestown, MA 02129
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Marshall S, Bayley M, McCullagh S, Velikonja D, Berrigan L, Ouchterlony D, Weegar K. Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain Inj 2015; 29:688-700. [DOI: 10.3109/02699052.2015.1004755] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Shawn Marshall
- Ottawa Hospital Research Institute, Ottawa, ON, Canada,
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada,
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,
- Department of Medicine, University of Toronto, Toronto, ON, Canada,
| | - Scott McCullagh
- Hamilton Health Sciences, Hamilton, ON, Canada,
- Department of Pscyhiatry, McMaster University, Hamilton, ON, Canada,
| | - Diana Velikonja
- Hamilton Health Sciences, Hamilton, ON, Canada,
- Department of Pscyhiatry, McMaster University, Hamilton, ON, Canada,
| | | | | | - Kelly Weegar
- Ottawa Hospital Research Institute, Ottawa, ON, Canada,
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Sleep and wake disturbances following traumatic brain injury. ACTA ACUST UNITED AC 2014; 62:252-61. [DOI: 10.1016/j.patbio.2014.05.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 05/13/2014] [Indexed: 01/16/2023]
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Shih CC, Hsu YT, Wang HH, Chen TL, Tsai CC, Lane HL, Yeh CC, Sung FC, Chiu WT, Cherng YG, Liao CC. Decreased risk of stroke in patients with traumatic brain injury receiving acupuncture treatment: a population-based retrospective cohort study. PLoS One 2014; 9:e89208. [PMID: 24586597 PMCID: PMC3929662 DOI: 10.1371/journal.pone.0089208] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/05/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with traumatic brain injury (TBI) face increased risk of stroke. Whether acupuncture can help to protect TBI patients from stroke has not previously been studied. METHODS Taiwan's National Health Insurance Research Database was used to conduct a retrospective cohort study of 7409 TBI patients receiving acupuncture treatment and 29,636 propensity-score-matched TBI patients without acupuncture treatment in 2000-2008 as controls. Both TBI cohorts were followed until the end of 2010 and adjusted for immortal time to measure the incidence and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of new-onset stroke in the multivariable Cox proportional hazard models. RESULTS TBI patients with acupuncture treatment (4.9 per 1000 person-years) had a lower incidence of stroke compared with those without acupuncture treatment (7.5 per 1000 person-years), with a HR of 0.59 (95% CI = 0.50-0.69) after adjustment for sociodemographics, coexisting medical conditions and medications. The association between acupuncture treatment and stroke risk was investigated by sex and age group (20-44, 45-64, and ≥65 years). The probability curve with log-rank test showed that TBI patients receiving acupuncture treatment had a lower probability of stroke than those without acupuncture treatment during the follow-up period (p<0.0001). CONCLUSION Patients with TBI receiving acupuncture treatment show decreased risk of stroke compared with those without acupuncture treatment. However, this study was limited by lack of information regarding lifestyles, biochemical profiles, TBI severity, and acupuncture points used in treatments.
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Affiliation(s)
- Chun-Chuan Shih
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Yi-Ting Hsu
- Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Hwang-Huei Wang
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Centre, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chin-Chuan Tsai
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Hsin-Long Lane
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Chieh Yeh
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Wen-Ta Chiu
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Health Policy Research Centre, Taipei Medical University Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
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Wiseman-Hakes C, Murray B, Moineddin R, Rochon E, Cullen N, Gargaro J, Colantonio A. Evaluating the impact of treatment for sleep/wake disorders on recovery of cognition and communication in adults with chronic TBI. Brain Inj 2013; 27:1364-76. [PMID: 24070180 PMCID: PMC3809926 DOI: 10.3109/02699052.2013.823663] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/28/2013] [Accepted: 07/07/2013] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To longitudinally examine objective and self-reported outcomes for recovery of cognition, communication, mood and participation in adults with traumatic brain injury (TBI) and co-morbid post-traumatic sleep/wake disorders. DESIGN Prospective, longitudinal, single blind outcome study. SETTING Community-based. PARTICIPANTS Ten adults with moderate-severe TBI and two adults with mild TBI and persistent symptoms aged 18-58 years. Six males and six females, who were 1-22 years post-injury and presented with self-reported sleep/wake disturbances with onset post-injury. INTERVENTIONS Individualized treatments for sleep/wake disorders that included sleep hygiene recommendations, pharmacological interventions and/or treatments for sleep apnea with follow-up. MAIN OUTCOME MEASURES Insomnia Severity Index, Beck Depression and Anxiety Inventories, Latrobe Communication Questionnaire, Speed and Capacity of Language Processing, Test of Everyday Attention, Repeatable Battery for the Assessment of Neuropsychological Status, Daily Cognitive-Communication and Sleep Profile. RESULTS Group analysis revealed positive trends in change for each measure and across sub-tests of all measures. Statistically significant changes were noted in insomnia severity, p = 0.0003; depression severity, p = 0.03; language, p = 0.01; speed of language processing, p = 0.007. CONCLUSIONS These results add to a small but growing body of evidence that sleep/wake disorders associated with TBI exacerbate trauma-related cognitive, communication and mood impairments. Treatment for sleep/wake disorders may optimize recovery and outcomes.
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Affiliation(s)
- Catherine Wiseman-Hakes
- Department of Rehabilitation Science, University of TorontoToronto, ONCanada
- Toronto Rehabilitation InstituteToronto, ONCanada
| | - Brian Murray
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of TorontoToronto, ONCanada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
| | - Elizabeth Rochon
- Toronto Rehabilitation InstituteToronto, ONCanada
- Department of Speech Language Pathology, University of TorontoToronto, ONCanada
| | - Nora Cullen
- Toronto Rehabilitation InstituteToronto, ONCanada
- West Park Health Care CentreToronto, ONCanada
| | | | - Angela Colantonio
- Toronto Rehabilitation InstituteToronto, ONCanada
- Department of Occupational Therapy and Occupational Science, University of TorontoToronto, ONCanada
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Mollayeva T, Colantonio A, Mollayeva S, Shapiro CM. Screening for sleep dysfunction after traumatic brain injury. Sleep Med 2013; 14:1235-46. [PMID: 24211035 DOI: 10.1016/j.sleep.2013.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 07/12/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
Abstract
Numerous studies on the high prevalence of sleep disorders in individuals with traumatic brain injury (TBI) have been conducted in the past few decades. These disorders can accentuate other consequences of TBI, negatively impacting mood, exacerbating pain, heightening irritability, and diminishing cognitive abilities and the potential for recovery. Nevertheless, sleep is not routinely assessed in this population. In our review, we examined the selective screening criteria and the scientific evidence regarding screening for post-TBI sleep disorders to identify gaps in our knowledge that are in need of resolution. We retrieved papers written in the English-language literature before June 2012 pertinent to the discussion on sleep after TBI found through a PubMed search. Within our research, we found that sleep dysfunction is highly burdensome after TBI, treatment interventions for some sleep disorders result in favorable outcomes, sensitive and specific tests to detect sleep disorders are available, and the cost-effectiveness and sustainability of screening have been determined from other populations. The evidence we reviewed supports screening for post-TBI sleep dysfunction. This approach could improve the outcomes and reduce the risks for post-TBI adverse health and nonhealth effects (e.g., secondary injuries). A joint sleep and brain injury collaboration focusing on outcomes is needed to improve our knowledge.
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Affiliation(s)
- Tatyana Mollayeva
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario M5G 2A2, Canada; University of Toronto, Toronto, Ontario M5G 1V7, Canada.
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Interventions for Mood-Related Issues Post Traumatic Brain Injury: Novel Treatments and Ongoing Limitations of Current Research. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Reduced use of emergency care and hospitalization in patients with traumatic brain injury receiving acupuncture treatment. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:262039. [PMID: 23970929 PMCID: PMC3732621 DOI: 10.1155/2013/262039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/12/2013] [Accepted: 06/27/2013] [Indexed: 12/03/2022]
Abstract
Background. Little research exists on acupuncture treatment's effect on patients with traumatic brain injury (TBI). Methods. Using Taiwan's National Health Insurance Research Database, we conducted a cohort study to compare the use of emergency care and hospitalization in TBI patients with and without acupuncture treatment in the first year after TBI. The adjusted relative risks (RRs) and 95% confidence intervals (CIs) of high use of emergency care and hospitalization associated with acupuncture treatment were calculated in multivariate Poisson regression models with generalized estimating equation. Results. The means of medical visits of emergency care and hospitalization were lower in TBI patients with acupuncture treatment than in those without acupuncture treatment. After adjustment, acupuncture treatment was associated with decreased risk of high emergency care visits (beta = −0.0611, P = 0.0452) and hospitalization (beta = −0.0989, P < 0.0001). The RRs of high medical visits and expenditure for hospitalization associated with acupuncture treatment were 0.62 (95% CI = 0.50–0.76) and 0.66 (95% CI = 0.53–0.83), respectively. Conclusion. Patients with TBI who receive acupuncture treatment have reduced the use of emergency care and hospitalization in the first year after injury. The mechanisms of effects of acupuncture on TBI warrant further investigations.
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Use of Complementary and Alternative Medicine in Treating Individuals with Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0019-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Sleep disturbance is common after traumatic brain injury (TBI). Insomnia, fatigue, and sleepiness are the most frequent post-TBI sleep complaints with narcolepsy (with or without cataplexy), sleep apnea (obstructive or central), periodic limb movement disorder, and parasomnias occurring less commonly. In addition, depression, anxiety, and pain are common TBI comorbidities with substantial influence on sleep quality. Diagnosis of sleep disorders after TBI may involve polysomnography, multiple sleep latency testing, or actigraphy. Treatment is disorder-specific and includes the use of medications, continuous positive airway pressure, or behavioral modifications. Unfortunately, treatment of sleep disorders associated with TBI often does not improve sleepiness or neuropsychologic function.
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Affiliation(s)
- Mari Viola-Saltzman
- Pritzker School of Medicine, NorthShore University Health System, Department of Neurology, 2650 Ridge Avenue, Evanston, IL 60201, USA
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Yan S, Zhang R, Zhou X, Li P, He L, Liu B. Exploring effective core drug patterns in primary insomnia treatment with Chinese herbal medicine: study protocol for a randomized controlled trial. Trials 2013; 14:61. [PMID: 23448313 PMCID: PMC3599277 DOI: 10.1186/1745-6215-14-61] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chinese herbal medicine is one of the most popular Chinese medicine (CM) therapies for primary insomnia. One of the important characteristics of CM is that different Chinese clinicians give different prescriptions even for the same patient. However, there must be some fixed drug patterns in every clinician's prescriptions. This study aims to screen the effective core drug patterns in primary insomnia treatment of three prestigious Chinese clinicians. METHODS/DESIGN A triple-blind, randomized, placebo-controlled, parallel-group clinical trial will be performed. Three clinicians will diagnose and treat every eligible patient individually and independently, producing three prescriptions from three clinicians for every patient. Patients will equally be randomized to one of four groups - medical group A, medical group B, medical group C, or placebo group - and observed for efficacy of treatment. The sample will include primary insomnia patients meeting DSM IV-TR criteria, Spiegel scale score >18, and age 18 to 65 years. A sequential design is employed. Interim analysis will be conducted when between 80 and 160 patients complete the study. The interim study could be stopped and treated as final if a statistically significant difference between treatment and placebo groups can be obtained and core effective drug patterns can be determined. Otherwise, the study continues until the maximum sample size reaches 300. Treatment of the CM group is one of three Chinese clinicians' prescriptions, who provide independently prescriptions based on their own CM theory and the patient's disease condition. Assessment will be by sleep diary and Pittsburgh sleep quality index, and CM symptoms and signs will be measured. Primary outcome is total sleep time. Assessment will be carried out at the washout period, weeks 1, 2, 3, and 4 and 4th week after the end of treatment. Effectiveness analysis will be per intent to treat. A multi-dimension association rule and scale-free networks method will be used to explore the effective core drug patterns. DISCUSSION The effective core drug patterns will be found through analyzing several prestigious CM clinicians' treatment information. Screening the effective core drug patterns from prestigious clinicians can accelerate the development of new CM drugs. TRIAL REGISTRATION NCT01613183.
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Affiliation(s)
- Shiyan Yan
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No.16 NanXiaoJie, DongZhiMenNei, DongCheng District, Beijing, China
| | - Runshun Zhang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, No.5 BeiXianGe St., XiCheng District, Beijing, China
| | - Xuezhong Zhou
- School of Computer and Information Technology, Beijing Jiaotong University, No.3 ShangYuanCun, Hai Dian District, Beijing, China
| | - Peng Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No.16 NanXiaoJie, DongZhiMenNei, DongCheng District, Beijing, China
| | - Liyun He
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No.16 NanXiaoJie, DongZhiMenNei, DongCheng District, Beijing, China
| | - Baoyan Liu
- China Academy of Chinese Medical Sciences, No.16 NanXiaoJie, DongZhiMenNei, DongCheng District, Beijing, China
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Abstract
Insomnia appears to be a fast-spreading problem in the modern days, which not only affects people's living quality but also impairs people's working efficiency even causing disability. Pharmacological treatment is effective but frequently with significant side effects. Acupuncture is traditionally used for the treatment of insomnia in China and now is widely accepted in the Western countries. Many research works on clinical applications of acupuncture in the treatment of insomnia and the potential mechanisms underlying the acupuncture treatment have been reported. This chapter will try to provide a systematic review on the research findings. A number of clinical studies, mainly randomized controlled clinical trials, have shown positive effects in acupuncture treatment of insomnia. Some of the studies demonstrated that acupuncture treatment appeared to be better than conventional pharmacological drugs in the improvement of insomnia. These encouraging findings are limited by the qualities problems of the methodology used in these clinical studies. The clinical efficacy of acupuncture appeared to be supported by evidence obtained from basic neuroendocrinological studies. A number of studies have demonstrated that acupuncture may modulate a wide range of neuroendocrinological factors following stimulation of acupoints. Evidence has suggested that the clinical efficacy of acupuncture in treatment of insomnia is potentially mediated by a variety of neurotransmitters including norepinephrine, melatonin, gamma-aminobutyric acid, and β-endorphin. However, due to the complexity, these findings are far from conclusive. More research is necessary. More rigors methodology and integrated approach to evaluate both clinical and basic research evidence are required for future studies.
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