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Mills SJ, Halstead H, Howie J, Hutchins S, Forte L, Unsworth D, Walters T, Jelbart M, Dodd B, van den Berg M, Killington M. Team-based rehabilitation after mild traumatic brain injury - description of the clinical pathway. Brain Inj 2024; 38:807-817. [PMID: 38695320 DOI: 10.1080/02699052.2024.2347570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/20/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Describe clinical practice, inter-disciplinary clinical pathway and core principles of care within a mild traumatic brain injury (mTBI) rehabilitation team. METHODS An observational study examined inter-disciplinary practice, nested within an observational trial investigating team-based mTBI rehabilitation. Data were collected to describe clinical service over 12 months. Activity data quantified clinical sessions per participant, mode of service delivery and content of sessions using custom-designed codes. The clinical team gathered narrative data to confirm the inter-disciplinary clinical pathway and individual discipline practice. RESULTS 168 participants entered the rehabilitation program during the 12 months. A single Allied Health Screening Assessment identified patient priorities. Occupational Therapy (OT) and Physiotherapy (PT) provided the majority of clinical sessions; the team also comprised Social Work, Rehabilitation Medicine, Speech Pathology and Clinical Psychology. Telehealth was the most common service delivery mode (54%). Median session numbers per participant ranged 1-4 for all disciplines; mean/maximum occasions of service were highest for PT (6.9/44) and OT (6.8/39). CONCLUSION A small proportion of participants received much higher number of sessions, consistent with intractable issues after mTBI. High attendance rates indicate the predominantly telehealth-delivered model was feasible. The clinical approach included early prioritizing of discipline input and follow-up after discharge.
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Affiliation(s)
- Simon J Mills
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Hannah Halstead
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Joanne Howie
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Selena Hutchins
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Leah Forte
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - David Unsworth
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Terri Walters
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Miranda Jelbart
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Beverley Dodd
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Maayken van den Berg
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Maggie Killington
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Backus BE, Moustafa F, Skogen K, Sapin V, Rane N, Moya-Torrecilla F, Biberthaler P, Tenovuo O. Consensus paper on the assessment of adult patients with traumatic brain injury with Glasgow Coma Scale 13-15 at the emergency department: A multidisciplinary overview. Eur J Emerg Med 2024; 31:240-249. [PMID: 38744295 DOI: 10.1097/mej.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Traumatic brain injury (TBI) is a common reason for presenting to emergency departments (EDs). The assessment of these patients is frequently hampered by various confounders, and diagnostics is still often based on nonspecific clinical signs. Throughout Europe, there is wide variation in clinical practices, including the follow-up of those discharged from the ED. The objective is to present a practical recommendation for the assessment of adult patients with an acute TBI, focusing on milder cases not requiring in-hospital care. The aim is to advise on and harmonize practices for European settings. A multiprofessional expert panel, giving consensus recommendations based on recent scientific literature and clinical practices, is employed. The focus is on patients with a preserved consciousness (Glasgow Coma Scale 13-15) not requiring in-hospital care after ED assessment. The main results of this paper contain practical, clinically usable recommendations for acute clinical assessment, decision-making on acute head computerized tomography (CT), use of biomarkers, discharge options, and needs for follow-up, as well as a discussion of the main features and risk factors for prolonged recovery. In conclusion, this consensus paper provides a practical stepwise approach for the clinical assessment of patients with an acute TBI at the ED. Recommendations are given for the performance of acute head CT, use of brain biomarkers and disposition after ED care including careful patient information and organization of follow-up for those discharged.
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Affiliation(s)
- Barbra E Backus
- Emergency Department, Franciscus Gasthuis and Vlietland, Rotterdam
- Emergency Department, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Farès Moustafa
- Emergency Department, University Hospital Clermont Auvergne, Clermont-Ferrand, France
| | - Karoline Skogen
- Department of Radiology and Nuclear Medicine, Oslo University Hospitals, Oslo, Norway
| | - Vincent Sapin
- Biochemistry and Molecular Genetics Department, University Hospital Clermont Auvergne, Clermont-Ferrand, France
| | - Neil Rane
- Department of Neuroradiology, St Marys Hospital Major Trauma Centre, Imperial College London NHS Trust
| | - Francisco Moya-Torrecilla
- Physical Therapy Department, School of Health Sciences, University of Malaga, Spain
- International Medical Services, Vithas Xanit International Hospital, Malaga, Spain
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar Technische Universität, Munich, Germany
| | - Olli Tenovuo
- Department of Clinical Medicine, University of Turku, Turku, Finland
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3
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Colclough Z, Estrella MJ, Joyce JM, Hanafy S, Babineau J, Colantonio A, Chan V. Equity considerations in clinical practice guidelines for traumatic brain injury and the criminal justice system: A systematic review. PLoS Med 2024; 21:e1004418. [PMID: 39134041 PMCID: PMC11319042 DOI: 10.1371/journal.pmed.1004418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/22/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is disproportionately prevalent among individuals who intersect or are involved with the criminal justice system (CJS). In the absence of appropriate care, TBI-related impairments, intersecting social determinants of health, and the lack of TBI awareness in CJS settings can lead to lengthened sentences, serious disciplinary charges, and recidivism. However, evidence suggests that most clinical practice guidelines (CPGs) overlook equity and consequently, the needs of disadvantaged groups. As such, this review addressed the research question "To what extent are (1) intersections with the CJS considered in CPGs for TBI, (2) TBI considered in CPGs for CJS, and (3) equity considered in CPGs for CJS?". METHODS AND FINDINGS CPGs were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of identified CPGs on November 2021 and March 2023 (CPGs for TBI) and May 2022 and March 2023 (CPGs for CJS). Only CPGs for TBI or CPGs for CJS were included. We calculated the proportion of CPGs that included TBI- or CJS-specific content, conducted a qualitative content analysis to understand how evidence regarding TBI and the CJS was integrated in the CPGs, and utilised equity assessment tools to understand if and how equity was considered. Fifty-seven CPGs for TBI and 6 CPGs for CJS were included in this review. Fourteen CPGs for TBI included information relevant to the CJS, but only 1 made a concrete recommendation to consider legal implications during vocational evaluation in the forensic context. Two CPGs for CJS acknowledged the prevalence of TBI among individuals in prison and one specifically recommended considering TBI during health assessments. Both CPGs for TBI and CPGs for CJS provided evidence specific to a single facet of the CJS, predominantly in policing and corrections. The use of equity best practices and the involvement of disadvantaged groups in the development process were lacking among CPGs for CJS. We acknowledge limitations of the review, including that our searches were conducted in English language and thus, we may have missed other non-English language CPGs in this review. We further recognise that we are unable to comment on evidence that is not integrated in the CPGs, as we did not systematically search for research on individuals with TBI who intersect with the CJS, outside of CPGs. CONCLUSIONS Findings from this review provide the foundation to consider CJS involvement in CPGs for TBI and to advance equity in CPGs for CJS. Conducting research, including investigating the process of screening for TBI with individuals who intersect with all facets of the CJS, and utilizing equity assessment tools in guideline development are critical steps to enhance equity in healthcare for this disadvantaged group.
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Affiliation(s)
- Zoe Colclough
- Department of Forensic Science, University of Toronto, Mississauga, Canada
| | - Maria Jennifer Estrella
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Julie Michele Joyce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Sara Hanafy
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, Canada
- The Institute for Education Research, University Health Network, Toronto, Canada
| | - Angela Colantonio
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vincy Chan
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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4
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Corazon SS, Olsen LJ, Kæreby N, Poulsen DV, Sidenius U, Bekke-Hansen S, Marschner L. Nature-Based Therapeutic Intervention for Individuals with Post-Concussion Symptoms. Behav Sci (Basel) 2024; 14:594. [PMID: 39062417 PMCID: PMC11273594 DOI: 10.3390/bs14070594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
This study investigated the efficacy of a 10-session nature-based therapeutic intervention for people with post-concussion symptoms. The intervention involved physical and vestibular exercises, sensory training, relaxation, and psychoeducation, all of which were integrated with the natural environment in a forest therapy garden. This study was designed with a passive control period followed by the intervention (n = 30). The Mental Fatigue Scale (MFS) was the primary outcome measure. The secondary outcome measures were the Warwick-Edinburg Mental Wellbeing Scale and the short version of the Quality of Life after Brain Injury. A Likert scale was used to examine the mental strain of the sessions themselves. The MFS (primary outcome) exhibited a significant decrease with a medium-sized effect from before to after the intervention. The secondary outcomes exhibited significant increases from the beginning to the end of the intervention. All outcomes were sustained at follow-up ten weeks later. No significant difference was found from the control period. This study indicates that the described nature-based intervention is a feasible treatment for reducing prolonged post-concussion symptoms. However, it should be studied more in-depth to understand the impact of the natural environment and to validate the results on a larger representative population.
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Affiliation(s)
- Sus Sola Corazon
- Department of Geosciences and Natural Resource Management, University of Copenhagen, 1958 Frederiksberg, Denmark; (D.V.P.); (U.S.); (S.B.-H.)
| | | | | | - Dorthe Varning Poulsen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, 1958 Frederiksberg, Denmark; (D.V.P.); (U.S.); (S.B.-H.)
| | - Ulrik Sidenius
- Department of Geosciences and Natural Resource Management, University of Copenhagen, 1958 Frederiksberg, Denmark; (D.V.P.); (U.S.); (S.B.-H.)
| | - Stine Bekke-Hansen
- Department of Geosciences and Natural Resource Management, University of Copenhagen, 1958 Frederiksberg, Denmark; (D.V.P.); (U.S.); (S.B.-H.)
| | - Linda Marschner
- Center for Rehabilitation of Brain Injury Denmark, 2300 Copenhagen, Denmark;
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Gerhalter T, Chen AM, Dehkharghani S, Peralta R, Gajdosik M, Zarate A, Bushnik T, Silver JM, Im BS, Wall SP, Madelin G, Kirov II. Longitudinal changes in sodium concentration and in clinical outcome in mild traumatic brain injury. Brain Commun 2024; 6:fcae229. [PMID: 39035416 PMCID: PMC11258572 DOI: 10.1093/braincomms/fcae229] [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: 01/17/2024] [Revised: 06/10/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024] Open
Abstract
Ionic imbalances and sodium channel dysfunction, well-known sequelae of traumatic brain injury (TBI), promote functional impairment in affected subjects. Therefore, non-invasive measurement of sodium concentrations using 23Na MRI has the potential to detect clinically relevant injury and predict persistent symptoms. Recently, we reported diffusely lower apparent total sodium concentrations (aTSC) in mild TBI patients compared to controls, as well as correlations between lower aTSC and worse clinical outcomes. The main goal of this study was to determine whether these aTSC findings, and their changes over time, predict outcomes at 3- and 12-month from injury. Twenty-seven patients previously studied with 23Na MRI and outcome measures at 22 ± 10 days (average ± standard deviation) after injury (visit-1, v1) were contacted at 3- (visit-2, v2) and 12-month after injury (visit-3, v3) to complete the Rivermead post-concussion symptoms questionnaire (RPQ), the extended Glasgow outcome scale (GOSE), and the brief test of adult cognition by telephone (BTACT). Follow-up 1H and 23Na MRI were additionally scheduled at v2. Linear regression was used to calculate aTSC in global grey and white matters. Six hypotheses were tested in relation to the serial changes in outcome measures and in aTSC, and in relation to the cross-sectional and serial relationships between aTSC and outcome. Twenty patients contributed data at v2 and fifteen at v3. Total RPQ and composite BTACT z-scores differed significantly for v2 and v3 in comparison to v1 (each P < 0.01), reflecting longitudinally reduced symptomatology and improved performance on cognitive testing. No associations between aTSC and outcome were observed at v2. Previously lower grey and white matter aTSC normalized at v2 in comparison to controls, in line with a statistically detectable longitudinal increase in grey matter aTSC between v1 and v2 (P = 0.0004). aTSC values at v1 predicted a subset of future BTACT subtest scores, but not future RPQ scores nor GOSE-defined recovery status. Similarly, aTSC rates of change correlated with BTACT rates of change, but not with those of RPQ. Tissue aTSC, previously shown to be diffusely decreased compared to controls at v1, was no longer reduced by v2, suggesting normalization of the sodium ionic equilibrium. These changes were accompanied by marked improvement in outcome. The results support the notion that early aTSC from 23Na MRI predicts future BTACT, but not RPQ scores, nor future GOSE status.
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Affiliation(s)
- Teresa Gerhalter
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Anna M Chen
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Seena Dehkharghani
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Rosemary Peralta
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Mia Gajdosik
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Alejandro Zarate
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Tamara Bushnik
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Jonathan M Silver
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Brian S Im
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Guillaume Madelin
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Ivan I Kirov
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Center for Advanced Imaging Innovation and Research (CAIR), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY 10016, USA
- Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016, USA
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6
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Nisted I, Hellemose LA, Eggertsen PP, Odgaard L, Bek T, Nielsen JF. Convergence insufficiency in patients with post-concussion syndrome is accompanied by a higher symptom load: a cross-sectional study. Brain Inj 2024; 38:645-651. [PMID: 38530005 DOI: 10.1080/02699052.2024.2334355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To estimate the prevalence of convergence insufficiency (CI) in adult patients with post-concussion syndrome and determine the impact of CI on symptom load. METHODS Cross-sectional study of 103 patients with neurological symptoms 2-6 months after a concussion. Symptoms were assessed with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and CI was diagnosed using near point of convergence, vergence facility, and the Convergence Insufficiency Symptom Survey. The RPQ score for patients with and without CI was compared, and sensitivity, specificity, and area under the receiver operating characteristic curve for the two visually related RPQ questions as indicators of CI were calculated. RESULTS The proportion of patients diagnosed with symptomatic CI was 20.4% (95% confidence interval: 13.1-29.5%). The RPQ score was significantly higher for patients with symptomatic CI both before (p = .01) and after removal of the two visually related questions in the RPQ-questionnaire (p = .03). The two visually related RPQ questions were unable to detect CI. CONCLUSION In patients with post-concussion syndrome, the load of nonvisual symptoms is higher in the presence of CI. A prospective interventional study on CI is required to study the relationship between CI and other post-concussion symptoms.
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Affiliation(s)
- Ivan Nisted
- Danish College of Optometry and Vision Science, Dania Academy, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Line Amalie Hellemose
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Peter Preben Eggertsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Lene Odgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
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O'Brien KH, Pei Y, Kemp AM, Gartell R, Wallace T. Pilot testing the SUCCESS peer mentoring program for students with concussion: the role of personas in mobile technology development. Disabil Rehabil Assist Technol 2024; 19:1964-1979. [PMID: 37522162 DOI: 10.1080/17483107.2023.2239293] [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: 11/30/2022] [Revised: 05/12/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE College students with concussion experience academic, cognitive and psychosocial challenges, yet frequently lack supports necessary for successful reintegration into school. Success in College after Concussion with Effective Student Supports (SUCCESS) is a virtual peer mentoring program designed to provide education, support and connection through a mobile application. The purpose of this study was to describe use of personas as components of mobile app development and conduct preliminary testing of SUCCESS using personas. METHODS Personas were developed from case studies and portrayed by college students trained as fictitious mentees. Mentors were blinded to use of personas. Eleven mentors completed measures pre and post a 4-week mentoring cycle. Mentors and personas interacted in the app via chat, video calls and sharing of educational materials. Measures included the Post-Concussion Symptom Scale (PCSS); PROMIS Self-Efficacy; Depression, Anxiety and Stress Scale (DASS); and a series of focus groups. RESULTS Mentors suggested improvements to resolve instability of video calls, expand educational materials to address psychosocial functioning, and add structure to the mentoring relationship. Some preferences around communication, like groups chats and emoji keyboards, were not able to be addressed. As expected, PCSS scores were stable. DASS score (p = .04), especially depression (p = .03), decreased. PROMIS scores showed a trend towards growth (p = .057), although were not statistically significant. CONCLUSIONS Use of personas allowed technical challenges and program refinements to be addressed before including students with subacute concussion in testing. Although continued development will address enhancement of communication modalities preferred by students, future efficacy testing of SUCCESS is warranted.
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Affiliation(s)
- Katy H O'Brien
- Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
| | - Yalian Pei
- Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
| | - Amy M Kemp
- Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
| | - Rebecca Gartell
- Shepherd Center, Crawford Research Institute, Complex Concussion Clinic, SHARE Military Initiative, Atlanta, GA, USA
| | - Tracey Wallace
- Shepherd Center, Crawford Research Institute, Complex Concussion Clinic, SHARE Military Initiative, Atlanta, GA, USA
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Lubbers VF, van den Hoven DJ, van der Naalt J, Jellema K, van den Brand C, Backus B. Emergency Department Risk Factors for Post-Concussion Syndrome After Mild Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2024; 41:1253-1270. [PMID: 38390830 DOI: 10.1089/neu.2023.0302] [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] [Indexed: 02/24/2024] Open
Abstract
Approximately 16% of patients with mild traumatic brain injury (mTBI) develop a post-concussion syndrome (PCS) with persistent physical, neurological, and behavioral complaints. PCS has a great impact on a patient's quality of life, often decreases the ability to return to work, and henceforth has a great economic impact. Recent studies suggest that early treatment can greatly improve prognosis and prevent long-term effects in these patients. However, early recognition of patients at high risk of PCS remains difficult. The objective of this systematic review is to assess risk factors associated with the development of PCS, primarily aimed at the group of non-hospitalized patients who were seen with mTBI at the emergency department (ED). We searched PubMed/MEDLINE, Cochrane Library and EMBASE on September 23, 2022, for prospective studies that assessed the risk factors for the development of PCS. Exclusion criteria were: retrospective studies; > 20% computed tomography (CT) abnormalities, <18 years of age, follow-up <4 weeks, severe trauma, and study population <100 patients. The search strategy identified 1628 articles, of which 17 studies met eligibility criteria. Risk factors found in this systematic review are pre-existing psychiatric history, headache at the ED, neurological symptoms at the ED, female sex, CT abnormalities, pre-existent sleeping problems, and neck pain at the ED. This systematic review identified seven risk factors for development of PCS in patients with mTBI. Future research should assess if implementation of these risk factors into a risk stratification tool will assist the emergency physician in the identification of patients at high risk of PCS.
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Affiliation(s)
- Veerle F Lubbers
- Erasmus University Medical Center, Rotterdam, the Netherlands
- Haaglanden Medical Center, the Hague, the Netherlands
| | | | | | - Korné Jellema
- Haaglanden Medical Center, the Hague, the Netherlands
| | - Crispijn van den Brand
- Erasmus University Medical Center, Rotterdam, the Netherlands
- Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
| | - Barbra Backus
- Franciscus Gasthuis and Vlietland Hospital, Rotterdam, the Netherlands
- Elisabeth Tweesteden Ziekenhuis, Tilburg, the Netherlands
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9
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Déry J, Fortin-Bédard N, de Guise É, Lamontagne ME. " I hope it'll get better… in the end, it didn't really get better": a qualitative study of access to specialized rehabilitation services as experienced by adults with persistent MTBI symptoms. Disabil Rehabil 2024; 46:2414-2423. [PMID: 37332218 DOI: 10.1080/09638288.2023.2224084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE Persistent symptoms experienced by adults following mild traumatic brain injury (mTBI) can significantly impact their daily activities. It is often difficult for them to access specialized rehabilitation services. The aim of this study is to explore this population's experience surrounding access to specialized rehabilitation services, including waiting time. MATERIALS AND METHODS This study used a qualitative phenomenological approach and was conducted using semi-structured interviews. Twelve adults with mTBI who had received specialized interdisciplinary rehabilitation services were recruited. The interviews focused on participants' recollection of their patient journey after injury, their perception of waiting, barriers and facilitators to access, and the impacts of these experiences on their condition. RESULTS Participants reported experiencing symptoms such as anxiety, depression, worry, sadness, and discouragement before accessing specialized services. They all agreed that they did not receive clear information about their recovery process or the health services available to them, which exacerbated their mental health symptoms. CONCLUSION The findings show that participants experienced uncertainty because they lacked information regarding recovery and access to health services after their injury. Education about symptoms and recovery, as well as emotional support for people with mTBI should be made available during the waiting period.
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Affiliation(s)
- Julien Déry
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Québec, Canada
| | - Noémie Fortin-Bédard
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Québec, Canada
| | - Élaine de Guise
- Department of Psychology, Université de Montréal, Montréal, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montréal, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montréal, Canada
| | - Marie-Eve Lamontagne
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (Cirris), Québec, Canada
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Moore BM, Stark RK, D'Angelo EC. Multidisciplinary care for patients with persistent symptoms following concussion: a systematic review. Disabil Rehabil 2024; 46:1760-1775. [PMID: 37147858 DOI: 10.1080/09638288.2023.2205663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE To systematically characterize and assess the effectiveness of multidisciplinary care for patients with persistent post-concussion symptoms (PPCS). MATERIALS AND METHODS Only studies describing multidisciplinary treatment, defined as intervention provided by no less than 2 healthcare disciplines, each with independent scopes of practice, for patients with PPCS were considered. RESULTS A total of 8 of the 1357 studies identified were included. The studies were comprised of heterogenous patient populations, care delivery systems, healthcare providers, treatment approaches, and outcomes. CONCLUSIONS Findings suggest multidisciplinary care, using a needs-based approach with individual- or group-based interventions, may be more beneficial than usual care to; 1) immediately reduce concussion-related symptom complaints and improve mood and quality of life in adolescents following sports-related concussion (SRC) and, 2) may produce immediate and lasting improvements in symptom complaints of young, primarily female, adults following a non-SRC. Future studies should clearly describe the decision-making processes used to deliver care through a needs-based approach and prioritize the inclusion of objective, performance-based measures to assess outcomes.
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Affiliation(s)
- Brian M Moore
- Department of Physical Therapy, CA State University, Sacramento, CA, USA
| | - Rachel K Stark
- Research and Instruction Department, California State University, Sacramento, CA, USA
| | - Elisabeth C D'Angelo
- Department of Communication Sciences and Disorders, California State University, Sacramento, CA, USA
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11
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Klinkhammer S, Duits AA, Deckers K, Horn J, Slooter AJC, Verwijk E, van Heugten CM, Visser-Meily JMA. A Biopsychosocial Approach to Persistent Post-COVID-19 Fatigue and Cognitive Complaints: Results of the Prospective Multicenter NeNeSCo Study. Arch Phys Med Rehabil 2024; 105:826-834. [PMID: 38228250 DOI: 10.1016/j.apmr.2023.12.014] [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: 07/19/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To evaluate whether psychological and social factors complement biomedical factors in understanding post-COVID-19 fatigue and cognitive complaints. Additionally, to incorporate objective (neuro-cognitive) and subjective (patient-reported) variables in identifying factors related to post-COVID-19 fatigue and cognitive complaints. DESIGN Prospective, multicenter cohort study. SETTING Six Dutch hospitals. PARTICIPANTS 205 initially hospitalized (March-June 2020), confirmed patients with SARS-CoV-2, aged ≥18 years, physically able to visit the hospital, without prior cognitive deficit, magnetic resonance imaging (MRI) contraindication, or severe neurologic damage post-hospital discharge (N=205). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Nine months post-hospital discharge, a 3T MRI scan and cognitive testing were performed and patients completed questionnaires. Medical data were retrieved from medical dossiers. Hierarchical regression analyses were performed on fatigue severity (Fatigue Severity Scale; FSS) and cognitive complaints (Cognitive Consequences after Intensive Care Admission; CLC-IC; dichotomized into CLC-high/low). Variable blocks: (1) Demographic and premorbid factors (sex, age, education, comorbidities), (2) Illness severity (ICU/general ward, PROMIS physical functioning [PROMIS-PF]), (3) Neuro-cognitive factors (self-reported neurological symptoms, MRI abnormalities, cognitive performance), (4) Psychological and social factors (Hospital Anxiety and Depression Scale [HADS], Utrecht Coping List, Social Support List), and (5) Fatigue or cognitive complaints. RESULTS The final models explained 60% (FSS) and 48% (CLC-IC) variance, with most blocks (except neuro-cognitive factors for FSS) significantly contributing. Psychological and social factors accounted for 5% (FSS) and 11% (CLC-IC) unique variance. Higher FSS scores were associated with younger age (P=.01), lower PROMIS-PF (P<.001), higher HADS-Depression (P=.03), and CLC-high (P=.04). Greater odds of CLC-high were observed in individuals perceiving more social support (OR=1.07, P<.05). CONCLUSIONS Results show that psychological and social factors add to biomedical factors in explaining persistent post-COVID-19 fatigue and cognitive complaints. Objective neuro-cognitive factors were not associated with symptoms. Findings highlight the importance of multidomain treatment, including psychosocial care, which may not target biologically-rooted symptoms directly but may reduce associated distress.
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Affiliation(s)
- Simona Klinkhammer
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands
| | - Annelien A Duits
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Department of Medical Psychology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kay Deckers
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjen J C Slooter
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels Health Campus, Jette, Belgium
| | - Esmée Verwijk
- Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, the Netherlands; Center of Excellence for Rehabilitation Medicine and De Hoogstraat Rehabilitation, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Faerman A, Nabasny A, Wright B, Juengst SB. Associations of Nightmares and Sleep Disturbance With Neurobehavioral Symptoms Postconcussion. J Head Trauma Rehabil 2024; 39:E105-E112. [PMID: 38709831 DOI: 10.1097/htr.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
OBJECTIVE This study investigates the association of nightmares beyond general sleep disturbance on neurobehavioral symptoms in adults with mild traumatic brain injury (mTBI). DESIGN Secondary analysis of a concussion cohort study. PARTICIPANTS One hundred and eleven adults older than 20 years with mTBI were recruited from a specialized concussion treatment center. MAIN MEASURES Behavioral Assessment Screening Tool, Pittsburgh Sleep Quality Index, and self-report of nightmare frequency in the past 2 weeks. RESULTS Among adults with mTBI, nightmares accounted for the greatest amount of variability in negative affect (β = .362, P < .001), anxiety (β = .332, P < .001), and impulsivity (β = .270, P < .001) after adjusting for age and sex. Overall sleep disturbance had the strongest association with depression (β = .493, P < .001), fatigue (β = .449, P < .001), self-reported executive dysfunction (β = .376, P < .001), and overall burden from concussive symptoms (β = .477, P < .001). CONCLUSIONS Nightmares and sleep disturbance are differentially associated with variance in neurobehavioral symptoms. Nightmares were independently associated with neurobehavioral symptoms representing an excess of normal functioning (eg, anxiety, impulsivity), while general sleep disturbance was associated with neurobehavioral symptoms representing functioning below normal levels (eg, depression, fatigue, self-reported executive dysfunction). Clinical and research implications are discussed.
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Affiliation(s)
- Afik Faerman
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California (Dr Faerman); Departments of Applied Clinical Research (Mr Nabasny and Dr Wright) and Physical Medicine and Rehabilitation (Drs Wright and Juengst), University of Texas Southwestern Medical Center, Dallas; Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas (Dr Juengst); and Department of Physical Medicine and Rehabilitation, UT Health Sciences Center at Houston, Houston, Texas (Dr Juengst)
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13
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Temel MH, Erden Y, Bağcıer F. Assessing Patients Perception: Analyzing the Quality, Reliability, Comprehensibility, and the Mentioned Medical Concepts of Traumatic Brain Injury Videos on YouTube. World Neurosurg 2024; 185:e907-e914. [PMID: 38458253 DOI: 10.1016/j.wneu.2024.02.150] [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: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The aim of this study is to analyze the quality, reliability, comprehensibility, and the mentioned medical concepts of traumatic brain injury (TBI) related videos on YouTube. METHODS "Traumatic brain injury (TBI)" and Google Trends related queries were used, and 328 videos were included. Categorization, quality assessment via a 5-point Global Quality Scale, reliability evaluation using a modified DISCERN scale, comprehensibility assessment using Flesch-Kincaid Reading Ease and Flesch-Kincaid Grade Level, and consensus-based classification for usefulness were performed. Target audience categorization was content-based. Text mining techniques were used to identify biomedical terms in video transcripts. RESULTS Most of the videos were intended for nonhealthcare professionals and deemed useful. The videos had intermediate quality and a moderate level of reliability. The comprehensibility of the videos exceeded the recommended levels. Videos predominantly covered TBI symptoms, the severity of the condition, its impact on individuals, and possibly strategies related to diagnosis and treatment. CONCLUSIONS Results suggest the requirement for higher quality and reliability in YouTube content about TBI. Emphasis should be placed on clear and accurate language to promote comprehensibility. Continued research, guidelines, education, and platform oversight can enhance the spread of reliable health information on social media, benefiting creators, and consumers in this field.
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Affiliation(s)
- Mustafa Hüseyin Temel
- Physical Medicine and Rehabilitation Clinic, Üsküdar State Hospital, Istanbul, Türkiye.
| | - Yakup Erden
- Physical Medicine and Rehabilitation Clinic, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Türkiye
| | - Fatih Bağcıer
- Physical Medicine and Rehabilitation Clinic, Basaksehir Cam Sakura City Hospital, Istanbul, Türkiye
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14
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Buzzanca-Fried KE, Snyder AR, Bauer RM, Morgan-Daniel J, de Corcho CP, Addeo R, Lahey SM, Houck Z, Beneciuk JM. Psychological Constructs From the Fear Avoidance Model and Beyond as Predictors for Persisting Symptoms After Concussion: An Integrative Review. Arch Phys Med Rehabil 2024:S0003-9993(24)00949-3. [PMID: 38663576 DOI: 10.1016/j.apmr.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVES To identify the range of evidence for relationships between psychological factors using the Fear Avoidance Model (FAM) as a guiding framework and relevant clinical outcomes in adult patients with persisting symptoms after concussion (PSaC), develop a comprehensive understanding of psychological factors that have been identified as predictors of clinical outcomes for PSaC, and contribute to the theoretical framework of the FAM for PSaC. DATA SOURCES Six databases (CINAHL, Embase, PsycINFO, PubMed, SportDiscus, and Web of Science) were searched by a librarian for empirical and theoretical publications and experimental and quasi-experimental study designs. The literature search was not limited by publication date restrictions. Gray literature, with the exception of doctoral dissertations, was excluded. STUDY SELECTION We included studies in the English language consisting of human participants aged ≥18 years. Articles must have included both outcomes pertaining to PSaC (≥3mo after injury) and psychological constructs. DATA EXTRACTION One reviewer extracted data from the resulting studies using a standardized data extraction form designed for this review. Two reviewers independently assessed risk of bias using the Quality in Prognosis Studies tool. DATA SYNTHESIS This review found numerous psychological constructs, some directly linked to the FAM, that have potential prognostic relationships with PSaC. However, research remains limited and some psychological factors central to FAM were only identified in a small number of studies (catastrophizing, cogniphobia, and avoidance), whereas other psychological factors were studied more extensively (anxiety and depression). CONCLUSIONS There is the need for additional evidence, and this integrative review provides an adaptation of the FAM for PSaC to be used as a guiding preliminary framework for future research. Future research should aim to include psychological factors proposed in this modified FAM to fully understand PSaC.
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Affiliation(s)
- Katherine E Buzzanca-Fried
- Department of Rehabilitation Science, University of Florida, Gainesville, FL; Brooks Rehabilitation, Jacksonville, FL; Brooks Rehabilitation Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL.
| | - Aliyah R Snyder
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Russell M Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | | | - Christopher Perez de Corcho
- Brooks Rehabilitation, Jacksonville, FL; Brooks Rehabilitation Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL
| | - Russell Addeo
- Department of Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL
| | - Sarah M Lahey
- Department of Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL
| | - Zachary Houck
- Department of Behavioral Medicine, Brooks Rehabilitation, Jacksonville, FL
| | - Jason M Beneciuk
- Brooks Rehabilitation, Jacksonville, FL; Brooks Rehabilitation Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL; Department of Physical Therapy, University of Florida, Gainesville, FL, United States
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15
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Robertson-Benta CR, Pabbathi Reddy S, Stephenson DD, Sicard V, Hergert DC, Dodd AB, Campbell RA, Phillips JP, Meier TB, Quinn DK, Mayer AR. Cognition and post-concussive symptom status after pediatric mild traumatic brain injury. Child Neuropsychol 2024; 30:203-220. [PMID: 36825526 PMCID: PMC10447629 DOI: 10.1080/09297049.2023.2181946] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
Cognitive impairment and post-concussive symptoms (PCS) represent hallmark sequelae of pediatric mild traumatic brain injury (pmTBI). Few studies have directly compared cognition as a function of PCS status longitudinally. Cognitive outcomes were therefore compared for asymptomatic pmTBI, symptomatic pmTBI, and healthy controls (HC) during sub-acute (SA; 1-11 days) and early chronic (EC; approximately 4 months) post-injury phases. We predicted worse cognitive performance for both pmTBI groups relative to HC at the SA visit. At the EC visit, we predicted continued impairment from the symptomatic group, but no difference between asymptomatic pmTBI and HCs. A battery of clinical (semi-structured interviews and self-report questionnaires) and neuropsychological measures were administered to 203 pmTBI and 139 HC participants, with greater than 80% retention at the EC visit. A standardized change method classified pmTBI into binary categories of asymptomatic or symptomatic based on PCS scores. Symptomatic pmTBI performed significantly worse than HCs on processing speed, attention, and verbal memory at SA visit, whereas lower performance was only present for verbal memory for asymptomatic pmTBI. Lower performance in verbal memory persisted for both pmTBI groups at the EC visit. Surprisingly, a minority (16%) of pmTBI switched from asymptomatic to symptomatic status at the EC visit. Current findings suggest that PCS and cognition are more closely coupled during the first week of injury but become decoupled several months post-injury. Evidence of lower performance in verbal memory for both asymptomatic and symptomatic pmTBI suggests that cognitive recovery may be a process separate from the resolution of subjective symptomology.
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Affiliation(s)
- Cidney R Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Sharvani Pabbathi Reddy
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - David D Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Veronik Sicard
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Danielle C Hergert
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Richard A Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - John P Phillips
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Departments of Psychology and Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
- Departments of Psychology and Neurology, University of New Mexico, Albuquerque, NM, USA
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Karvandi E, Helmy A, Kolias AG, Belli A, Ganau M, Gomes C, Grey M, Griffiths M, Griffiths T, Griffiths P, Holliman D, Jenkins P, Jones B, Lawrence T, McLoughlin T, McMahon C, Messahel S, Newton J, Noad R, Raymont V, Sharma K, Sylvester R, Tadmor D, Whitfield P, Wilson M, Woodberry E, Parker M, Hutchinson PJ. Specialist healthcare services for concussion/mild traumatic brain injury in England: a consensus statement using modified Delphi methodology. BMJ Open 2023; 13:e077022. [PMID: 38070886 PMCID: PMC10729241 DOI: 10.1136/bmjopen-2023-077022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To establish a consensus on the structure and process of healthcare services for patients with concussion in England to facilitate better healthcare quality and patient outcome. DESIGN This consensus study followed the modified Delphi methodology with five phases: participant identification, item development, two rounds of voting and a meeting to finalise the consensus statements. The predefined threshold for agreement was set at ≥70%. SETTING Specialist outpatient services. PARTICIPANTS Members of the UK Head Injury Network were invited to participate. The network consists of clinical specialists in head injury practising in emergency medicine, neurology, neuropsychology, neurosurgery, paediatric medicine, rehabilitation medicine and sports and exercise medicine in England. PRIMARY OUTCOME MEASURE A consensus statement on the structure and process of specialist outpatient care for patients with concussion in England. RESULTS 55 items were voted on in the first round. 29 items were removed following the first voting round and 3 items were removed following the second voting round. Items were modified where appropriate. A final 18 statements reached consensus covering 3 main topics in specialist healthcare services for concussion; care pathway to structured follow-up, prognosis and measures of recovery, and provision of outpatient clinics. CONCLUSIONS This work presents statements on how the healthcare services for patients with concussion in England could be redesigned to meet their health needs. Future work will seek to implement these into the clinical pathway.
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Affiliation(s)
- Elika Karvandi
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Adel Helmy
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Angelos G Kolias
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Antonio Belli
- Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Mario Ganau
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Clint Gomes
- Royal Liverpool University Hospital, Liverpool, UK
- UK Sports Institute, Liverpool, UK
| | - Michael Grey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Michael Griffiths
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Neurology, Alder-Hey Children's NHS Trust, Liverpool, UK
| | - Timothy Griffiths
- Department of Cognitive Neurology, Newcastle University, Newcastle Upon Tyne, UK
- Institute of Neurology, University College London, London, UK
| | - Philippa Griffiths
- Sunderland & South Tyneside Community Acquired Brain Injury Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Damian Holliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Peter Jenkins
- Wessex Neuroscience Centre, Southampton General Hospital, Southampton, UK
- Imperial College London, London, UK
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University-Headingley Campus, Leeds, UK
- England Performance Unit, Rugby Football League Ltd, Leeds, UK
| | - Tim Lawrence
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Catherine McMahon
- Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal Infirmary, Northern Care Alliance, Liverpool, UK
| | - Shrouk Messahel
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Joanne Newton
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Rupert Noad
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Kanchan Sharma
- Department of Neurology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Richard Sylvester
- National Hospital for Neurology and Neurosurgery, London, London, UK
- Institute of Exercise and Health, University College London, London, UK
| | - Daniel Tadmor
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Medical, Leeds Rhinos Rugby League Club, Leeds, UK
| | | | - Mark Wilson
- Imperial College London, London, UK
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Woodberry
- Department of Neuropsychology, University of Cambridge, Cambridge, UK
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17
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Šarkić B, Douglas JM, Simpson A. A cross-sectional survey of non-specialist Australian audio-vestibular clinical practice for traumatic brain injury and rehabilitation. BRAIN IMPAIR 2023; 24:611-628. [PMID: 38167366 DOI: 10.1017/brimp.2022.35] [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] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study explored non-specialist audiological clinical practice in the context of traumatic brain injury (TBI), and whether such practices incorporated considerations of TBI-related complexities pertaining to identification, diagnosis and management of associated auditory and vestibular disturbances. DESIGN A cross-sectional online survey exploring clinical practice, TBI-related training and information provision was distributed to audiologists across Australia via Audiology Australia and social media. Fifty audiologists, 80% female and 20% male, participated in this study. Years of professional practice ranged from new graduate to more than 20 years of experience. RESULTS Clear gaps of accuracy in knowledge and practice across all survey domains relating to the identification, diagnosis and management of patients with auditory and/or vestibular deficits following TBI were evident. Further, of the surveyed audiologists working in auditory and vestibular settings, 91% and 86%, respectively, reported not receiving professional development for the diagnosis and management of post-traumatic audio-vestibular deficits. CONCLUSION Inadequate resources, equipment availability and TBI-related training may have contributed to the gaps in service provision, influencing audiological management of patients with TBI. A tailored TBI approach to identification, diagnosis and management of post-traumatic auditory and vestibular disturbances is needed.
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Affiliation(s)
- Bojana Šarkić
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Jacinta M Douglas
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- Summer Foundation, Victoria, Australia
| | - Andrea Simpson
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
- College of Health & Human Services, Charles Darwin University, Northern Territory, Australia
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18
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Koch C, Neros T. Concussion and vision screening. JOURNAL OF OPTOMETRY 2023; 16:315-316. [PMID: 37302954 PMCID: PMC10518758 DOI: 10.1016/j.optom.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 06/13/2023]
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Chan V, Estrella MJ, Hanafy S, Colclough Z, Joyce JM, Babineau J, Colantonio A. Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review. EClinicalMedicine 2023; 63:102152. [PMID: 37662521 PMCID: PMC10474365 DOI: 10.1016/j.eclinm.2023.102152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Background Clinical practice guidelines (CPGs) predominantly prioritise treatment and cost-effectiveness, which encourages a universal approach that may not address the circumstances of disadvantaged groups. We aimed to advance equity and quality of care for individuals experiencing homelessness and traumatic brain injury (TBI) by assessing the extent to which homelessness and TBI are integrated in CPGs for TBI and CPGs for homelessness, respectively, and the extent to which equity, including consideration of disadvantaged populations and the PROGRESS-Plus framework, is considered in these CPGs. Methods For this systematic review, CPGs for TBI or homelessness were identified from electronic databases (MEDLINE, Embase, CINAHL, PsycINFO), targeted websites, Google Search, and reference lists of eligible CPGs on November 16, 2021 and March 16, 2023. The proportion of CPGs that integrated evidence regarding TBI and homelessness was identified and qualitative content analysis was conducted to understand how homelessness is integrated in CPGs for TBI and vice versa. Equity assessment tools were utilised to understand the extent to which equity was considered in these CPGs. This review is registered with PROSPERO (CRD42021287696). Findings Fifty-eight CPGs for TBI and two CPGs for homelessness met inclusion criteria. Only three CPGs for TBI integrated evidence regarding homelessness by recognizing the prevalence of TBI in individuals experiencing homelessness and identifying housing as a consideration in the assessment and management of TBI. The two CPGs for homelessness acknowledged TBI as prevalent and recognised individuals experiencing TBI and homelessness as a disadvantaged population that should be prioritised in guideline development. Equity was rarely considered in the content and development of CPGs for TBI. Interpretation Considerations for equity in CPGs for homelessness and TBI are lacking. To ensure that CPGs reflect and address the needs of individuals experiencing homelessness and TBI, we have identified several guideline development priorities. Namely, there is a need to integrate evidence regarding homelessness and TBI in CPGs for TBI and CPGs for homelessness, respectively and engage disadvantaged populations in all stages of guideline development. Further, this review highlights an urgent need to conduct research focused on and with disadvantaged populations. Funding Canada Research Chairs Program (2019-00019) and the Ontario Ministry of Health and Long-Term Care (Grant #725A).
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Affiliation(s)
- Vincy Chan
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Maria Jennifer Estrella
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Sara Hanafy
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Zoe Colclough
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Julie Michele Joyce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Angela Colantonio
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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20
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Tracey AJ, Bateman AG, Baez SE, Covassin T. Effectiveness of interventions for the improvement of mental health and well-being post-concussion: a systematic review. Brain Inj 2023; 37:1135-1158. [PMID: 37256279 DOI: 10.1080/02699052.2023.2219901] [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: 11/27/2022] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To identify and assess the effectiveness and quality of interventions targeted at improving mental health, well-being, and psychosocial impairments post-concussion. DATA SOURCES EBSCOHost, SPORTSDiscus, PsychINFO, Medline (Web of Science), PubMed, and Embase databases. REVIEW METHODS This systematic review is reported in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement in exercise, rehabilitation, sport medicine and sports science (PERSiST). Articles were included if they: (1) were randomized controlled trials or repeated measures pre-posttest study designs, (2) reported mild traumatic brain injury (mTBI) or concussion injury, and (3) evaluated interventions targeting mental health, well-being, and psychosocial impairments post-injury. RESULTS Twenty-three studies were included which evaluated interventions targeting mental health, well-being, and psychosocial impairments post-concussion. Interventions included cognitive rehabilitation (n = 7), psychotherapy (n = 7), psychoeducational (n = 3), neurocognitive training (n = 4), neurocognitive training combined with cognitive rehabilitation (n = 1), and psychotherapy combined with cognitive rehabilitation (n = 1). The seven (100%) cognitive rehabilitation intervention studies and four of the five (80%) neurocognitive training intervention studies observed significant improvements in mental health and well-being outcomes. CONCLUSIONS Cognitive rehabilitation and neurocognitive training may be the most effective interventions for mental health and well-being impairments post-concussion. Researchers and clinicians should continue to explore the effectiveness of these interventions, specifically in populations most impacted by concussion (i.e. athletes).
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Affiliation(s)
- Allie J Tracey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - André G Bateman
- Department of Sociology, Psychology and Social Work, The University of the West Indies, Kingston, Jamaica
| | - Shelby E Baez
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
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21
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Déry J, Ouellet B, de Guise É, Bussières ÈL, Lamontagne ME. Prognostic factors for persistent symptoms in adults with mild traumatic brain injury: an overview of systematic reviews. Syst Rev 2023; 12:127. [PMID: 37468999 PMCID: PMC10357711 DOI: 10.1186/s13643-023-02284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/26/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is an increasing public health problem, because of its persistent symptoms and several functional consequences. Understanding the prognosis of a condition is an important component of clinical decision-making and can help to guide the prevention of persistent symptoms following mTBI. The prognosis of mTBI has stimulated several empirical primary research papers and many systematic reviews leading to the identification of a wide range of factors. We aim to synthesize these factors to get a better understanding of their breadth and scope. METHODS We conducted an overview of systematic reviews. We searched in databases systematic reviews synthesizing evidence about the prognosis of persistent symptoms after mTBI in the adult population. Two reviewers independently screened all references and selected eligible reviews based on eligibility criteria. They extracted relevant information using an extraction grid. They also rated independently the risk of bias using the ROBIS tool. We synthesized evidence into a comprehensive conceptual map to facilitate the understanding of prognostic factors that have an impact on persistent post-concussion symptoms. RESULTS From the 3857 references retrieved in a database search, we included 25 systematic reviews integrating the results of 312 primary articles published between 1957 and 2019. We examined 35 prognostic factors from the systematics reviews. No single prognostic factor demonstrated convincing and conclusive results. However, age, sex, and multiple concussions showed an affirmatory association with persistent post-concussion outcomes in systematic reviews. CONCLUSION We highlighted the need for a comprehensive picture of prognostic factors related to persistent post-concussion symptoms. We believe that these prognostic factors would guide clinical decisions and research related to prevention and intervention regarding persistent post-concussion symptoms. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020176676.
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Affiliation(s)
- Julien Déry
- School of Rehabilitation Sciences, Université Laval, Pavillon Ferdinand-Vandry, local 2475, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), 525, boul. Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada
| | - Béatrice Ouellet
- School of Rehabilitation Sciences, Université Laval, Pavillon Ferdinand-Vandry, local 2475, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), 525, boul. Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada
| | - Élaine de Guise
- Department of Psychology, Université de Montréal, Montréal, Canada
- Research Institute of the McGill University Health Centre (RI-MUHC), Montréal, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Montréal, Canada
| | - Ève-Line Bussières
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), 525, boul. Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada
- Department of Psychology, Université du Québec à Trois-Rivières, 3007 Michel-Sarrazin, 3600 rue Sainte-Marguerite, Trois-Rivières, QC, G9A 5H7, Canada
| | - Marie-Eve Lamontagne
- School of Rehabilitation Sciences, Université Laval, Pavillon Ferdinand-Vandry, local 2475, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada.
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), 525, boul. Wilfrid-Hamel, Québec, QC, G1M 2S8, Canada.
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22
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Grigg-Damberger MM. Sleep/Wake Disorders After Sports Concussion: Risks, Revelations, and Interventions. J Clin Neurophysiol 2023; 40:417-425. [PMID: 36930200 DOI: 10.1097/wnp.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
SUMMARY Sleep-wake disturbances (SWDs) are among the most prevalent, persistent, and often disregarded sequelae of traumatic brain injury. Identification and treatment of SWDs in patients with traumatic brain injury is important and can complement other efforts to promote maximum functional recovery. SWDs can accentuate other consequences of traumatic brain injury, negatively affect mood, exacerbate pain, heighten irritability, and diminish cognitive abilities and the potential for recovery. The risk for sports injuries increases when athletes are sleep deprived. Sleep deprivation increases risk-taking behaviors, predisposing to injuries. SWDs are an independent risk factor for prolonged recovery after sports-related concussion. SWDs following sports-related concussion have been shown to impede recovery, rehabilitation, and return to preinjury activities.
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23
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Schneider KJ, Patricios JS, Meeuwisse W, Schneider GM, Hayden KA, Premji Z, Ahmed OH, Blauwet C, Broglio S, Cantu RC, Davis GA, Dvorak J, Echemendia RJ, Emery CA, Iverson GL, Leddy JJ, Makdissi M, McCrea M, McNamee M, Putukian M, Yeates KO, Black AM, Burma JS, Critchley M, Eliason PH, Räisänen AM, Tabor JB, Toomey C, Ronksley PE, Cassidy JD. Amsterdam 2022 process: A summary of the methodology for the Amsterdam International Consensus on Concussion in Sport. Br J Sports Med 2023; 57:712-721. [PMID: 37316208 DOI: 10.1136/bjsports-2022-106663] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 06/16/2023]
Abstract
The purpose of this paper is to summarise the consensus methodology that was used to inform the International Consensus Statement on Concussion in Sport (Amsterdam 2022). Building on a Delphi process to inform the questions and outcomes from the 5th International Conference on Concussion in Sport, the Scientific Committee identified key questions, the answers to which would help encapsulate the current science in sport-related concussion and help guide clinical practice. Over 3½ years, delayed by 2 years due to the pandemic, author groups conducted systematic reviews on each selected topic. The 6th International Conference on Concussion in Sport was held in Amsterdam (27-30 October 2022) and consisted of 2 days of systematic review presentations, panel discussions, question and answer engagement with the 600 attendees, and abstract presentations. This was followed by a closed third day of consensus deliberations by an expert panel of 29 with observers in attendance. The fourth day, also closed, was dedicated to a workshop to discuss and refine the sports concussion tools (Concussion Recognition Tool 6 (CRT6), Sport Concussion Assessment Tool 6 (SCAT6), Child SCAT6, Sport Concussion Office Assessment Tool 6 (SCOAT6) and Child SCOAT6). We include a summary of recommendations for methodological improvements for future research that grew out of the systematic reviews.
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Affiliation(s)
- Kathryn J Schneider
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Geoff M Schneider
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation, Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert C Cantu
- Centre for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts, USA
- Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Jiri Dvorak
- Spine Unit, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Carolyn A Emery
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Grant L Iverson
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, SUNY Buffalo, Buffalo, New York, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael McNamee
- Department of Movement Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Swansea University, Swansea, UK
| | - Margot Putukian
- Major League Soccer, Major League Soccer, New York, New York, USA
| | - Keith Owen Yeates
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda M Black
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Anu M Räisänen
- Department of Physical Therapy Education - Oregon, Western University of Health Sciences College of Health Sciences - Northwest, Lebanon, Oregon, USA
| | | | - Clodagh Toomey
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Paul E Ronksley
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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24
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Buzzanca‐Fried K, Morgan‐Daniel J, Snyder A, Bauer R, Lahey S, Addeo R, Houck Z, Perez C, Beneciuk J. PROTOCOL: Fear avoidance model psychological factors as predictors for persistent post-concussion clinical outcomes: An integrative review. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1311. [PMID: 37131460 PMCID: PMC10052450 DOI: 10.1002/cl2.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Persisting symptoms after concussion (PSaC) include physical, cognitive, and psychological symptoms which contribute to rehabilitation challenges. Previous research has not thoroughly investigated the association between PSaC and pain-related psychological factors. Therefore, there is an opportunity to use current pain models, such as the Fear Avoidance Model (FAM), as a framework to explore these relationships. The goals of this integrative review are to (1) identify and describe range of evidence that explores relationships between psychological factors and clinical outcomes in patients with PSaC, and (2) develop a comprehensive understanding of FAM-specific psychological factors that have been identified as potential predictors of clinical outcomes in patients with PSaC. Methods This review will be based on principles and stages of an integrative review which will allow for inclusion of diverse methodologies: (1) problem formulation, (2) literature search, (3) data evaluation, (4) data analysis, and (5) presentation. Methods for reporting this review will be informed by the 2020 PRISMA guidelines for systematic reviews. Discussion The findings from this integrative review will inform healthcare professionals working in post-concussion rehabilitation settings regarding relationships between FAM psychological factors and PSaC-an area that until recently has not been thoroughly explored. Additionally, this review will inform the development of other reviews and clinical studies to further investigate relationships between FAM psychological factors and PSaC. Integrative Review Registration OSF DOI 10.17605/OSF.IO/CNGPW.
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Affiliation(s)
| | - Jane Morgan‐Daniel
- University of Florida Health Science Center LibrariesGainesvilleFloridaUSA
| | - Aliyah Snyder
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Russell Bauer
- Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleFloridaUSA
| | - Sarah Lahey
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Russell Addeo
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Zachary Houck
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Christopher Perez
- Brooks RehabilitationDepartment of Behavioral MedicineJacksonvilleFloridaUSA
| | - Jason Beneciuk
- Department of Rehabilitation ScienceUniversity of FloridaGainesvilleFloridaUSA
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25
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Malan L, van Wyk R, von Känel R, Ziemssen T, Vilser W, Nilsson PM, Magnusson M, Jujic A, Mak D, Steyn F, Malan NT. The chronic stress risk phenotype mirrored in the human retina as a neurodegenerative condition. Stress 2023:1-43. [PMID: 37154816 DOI: 10.1080/10253890.2023.2210687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The brain is the key organ that orchestrates the stress response which translates to the retina. The retina is an extension of the brain and retinal symptoms in subjects with neurodegenerative diseases substantiated the eye as a window to the brain. The retina is used in this study to determine whether chronic stress reflects neurodegenerative signs indicative of neurodegenerative conditions. A 3-year prospective cohort (n = 333; aged 46 ± 9 years) was stratified into stress-phenotype cases (n = 212) and controls (n = 121) by applying the Malan stress-phenotype index. Neurodegenerative risk markers included ischemia (astrocytic S100 calcium-binding protein B/S100B); 24h blood pressure, proteomics; inflammation (tumor-necrosis-factor-α/TNF-α); neuronal damage (neuron-specific-enolase); anti-apoptosis of retinal-ganglion-cells (beta-nerve-growth-factor), astrocytic activity (glial-fibrillary-acidic-protein); hematocrit (viscosity) and retinal follow-up data [vessels; stress-optic-neuropathy]. Stress-optic-neuropathy risk was calculated from two indices: a newly derived diastolic-ocular-perfusion-pressure cut-point ≥68 mmHg relating to the stress-phenotype; combined with an established cup-to-disc ratio cut-point ≥0.3. Higher stress-optic-neuropathy (39% vs. 17%) and hypertension (73% vs. 16%) prevalence was observed in the stress-phenotype cases vs. controls. Elevated diastolic-ocular-perfusion-pressure, indicating hypoperfusion, was related to arterial narrowing and trend for ischemia increases in the stress-phenotype. Ischemia in the stress-phenotype at baseline, follow-up and 3-yr changes was related to consistent inflammation (TNF-α and cytokine-interleukin-17-receptor-A), neuron-specific-enolase increases, consistent apoptosis (chitinase 3-like-1, low beta-nerve-growth-factor), glial-fibrillary-acidic-protein decreases, elevated viscosity, vein widening as risk marker of endothelial dysfunction in the blood-retinal-barrier, lower vein count, and elevated stress-optic-neuropathy. The stress-phenotype and related neurodegenerative signs of ongoing brain ischemia, apoptosis and endothelial dysfunction compromised blood-retinal-barrier permeability and optic nerve integrity. In fact, the stress-phenotype could identify persons at high risk of neurodegeneration to indicate a neurodegenerative condition.
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Affiliation(s)
- Leoné Malan
- Technology Transfer and Innovation-Support Office; Private Bag X1290, North-West University, Potchefstroom 2520, South Africa
| | - Roelof van Wyk
- Surgical Ophthalmologist; 85 Peter Mokaba Street, Potchefstroom, South Africa
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Tjalf Ziemssen
- Autonomic and Neuroendocrinological Laboratory Dresden, University Hospital Carl Gustav Carus; Technische Universität Dresden, Germany
| | - Walthard Vilser
- Institute of Biomedical Engineering and informatics; Technical University Ilmenau, Germany
- Department of Pediatrics and Adolescent Medicine, Section Neonatalogy; University Hospital, Jena, Germany
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University; Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University; Malmö, Sweden
- Hypertension in Africa Research Team (HART); North-West University, Potchefstroom, South Africa
- Department of Cardiology; Skåne University Hospital, Malmö, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University; Malmö Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University; Malmö, Sweden
| | - Daniel Mak
- Centre for Regenerative Medicine and Health; Hong Kong Institute of Science & Innovation, Chinese Academy of Sciences, Hong Kong, SAR, People's Republic of China
| | - Faans Steyn
- Statistical Consultation Services; North-West University, Potchefstroom, South Africa
| | - Nico T Malan
- Technology Transfer and Innovation-Support Office; Private Bag X1290, North-West University, Potchefstroom 2520, South Africa
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26
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Norman R, Flaugher T, Chang S, Power E. Self-Perception of Cognitive-Communication Functions After Mild Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:883-906. [PMID: 36645876 PMCID: PMC10166193 DOI: 10.1044/2022_ajslp-22-00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/01/2022] [Accepted: 10/19/2022] [Indexed: 05/10/2023]
Abstract
PURPOSE A mixed-method approach was used to investigate the lived experiences of adults with mild traumatic brain injury (mTBI). The study aimed to understand the perceived relationship between cognitive-communication problems, thinking and communication concerns, and neurobehavioral symptoms. We hypothesized that individuals with cognitive-communication problems would attribute their problems with communication to their mTBI history and their self-perceived problems would be correlated with symptomatology. METHOD The Neurobehavioral Symptom Inventory (NSI) and an online cognitive-communication survey was used to conduct a study of 30 adults with mTBI history. Quantitative survey and NSI scores were analyzed with content analysis and correlational statistics. RESULTS The average NSI Total score was 17 with the following subscale scores: somatic (5), affective (8), and cognitive (3.9). Participants reported problems with expressive communication (56%), comprehension (80%), thinking (63%), and social skills (60%). Content analysis revealed problems in the following areas: expression (e.g., verbal, and written language), comprehension (reading and verbal comprehension), cognition (e.g., attention, memory and speed of processing, error regulation), and functional consequences (e.g., academic work, social problems, and anxiety and stress). A Pearson correlation indicated a statistically significant relationship (p < .01) between the Communication Survey Total and the Total, Somatic, Affective, and Cognitive subscales. CONCLUSIONS This study highlights a multifactorial basis of cognitive-communication impairment in adults with mTBI. We show that those with mTBI history perceive difficulties with cognitive-communication skills: conversations, writing, and short-term memory/attention. Furthermore, those with mTBI perceive their cognitive-communication problems after injury have impacted their vocational, social, and academic success.
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Affiliation(s)
- Rocio Norman
- Department of Communication Sciences and Disorders, University of Texas Health Science Center at San Antonio
| | - Tara Flaugher
- Department of Neuroscience, Developmental and Regenerative Biology, University of Texas at San Antonio
| | - Sharon Chang
- Department of Otolaryngology—Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Emma Power
- University of Technology Sydney, Speech Pathology, New South Wales, Australia
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27
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Alim-Marvasti A, Kuleindiren N, Tiersen F, Johal M, Lin A, Selim H, Rifkin-Zybutz R, Mahmud M. Hierarchical clustering of prolonged post-concussive symptoms after 12 months: symptom-centric analysis and association with functional impairments. Brain Inj 2023; 37:317-328. [PMID: 36529935 PMCID: PMC10635586 DOI: 10.1080/02699052.2022.2158229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Following a concussion, approximately 15% of individuals experience persistent symptoms that can lead to functional deficits. However, underlying symptom-clusters that persist beyond 12 months have not been adequately characterized, and their relevance to functional deficits are unclear. The aim of this study was to characterize the underlying clusters of prolonged post-concussive symptoms lasting more than 12 months, and to investigate their association with functional impairments. METHODS Although hierarchical clustering is ideally suited in evaluating subjective symptom severities, it has not been applied to the Rivermead Post-Concussion Questionnaire (RPQ). The RPQ and functional impairments questions were administered via a smartphone application to 445 individuals who self-reported prolonged post-concussive symptoms. Symptom-clusters were obtained using agglomerative hierarchical clustering, and their association with functional deficits were investigated with sensitivity analyses, and corrected for multiple comparisons. RESULTS Five symptom-clusters were identified: headache-related, sensitivity to light and sound, cognitive, mood-related, and sleep-fatigue. Individuals with more severe RPQ symptoms were more likely to report functional deficits (p < 0.0001). Whereas the headache and sensitivity clusters were associated with at most one impairment, at-least-mild sleeping difficulties and fatigue were associated with four, and moderate-to-severe cognitive difficulties with five (all p < 0.01). CONCLUSIONS Symptom-clusters may be clinically useful for functional outcome stratification for targeted rehabilitation therapies. Further studies are required to replicate these findings in other cohorts and questionnaires, and to ascertain the effects of symptomatic intervention on functional outcomes.
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Affiliation(s)
- Ali Alim-Marvasti
- Research Division, Mindset Technologies Ltd, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | | | | | - Monika Johal
- Research Division, Mindset Technologies Ltd, London, UK
- School of Medicine, Imperial College London, London, UK
| | - Aaron Lin
- Research Division, Mindset Technologies Ltd, London, UK
- University of Birmingham Medical School, Birmingham, UK
| | - Hamzah Selim
- Research Division, Mindset Technologies Ltd, London, UK
| | | | - Mohammad Mahmud
- Research Division, Mindset Technologies Ltd, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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28
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Kuitunen I, Ponkilainen VT, Iverson GL, Isokuortti H, Luoto TM, Mattila VM. Increasing incidence of pediatric mild traumatic brain injury in Finland - a nationwide register study from 1998 to 2018. Injury 2023; 54:540-546. [PMID: 36564327 DOI: 10.1016/j.injury.2022.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
AIM The purpose of this study is to document the annual incidence and incidence trends of pediatric traumatic brain injury (pTBI) in Finland over the course of 21 years. METHODS We conducted a retrospective nationwide register-based cohort study and used the Finnish Care Register and Population information statistics from 1998 to 2018. The patient group includes all patients aged <18 at the time of injury. We included all emergency department (ED) visits and subsequent inpatient admissions (meaning at least one night in the hospital) with International Classification of Diseases diagnostic code S06*. We calculated pTBI incidences per 100,000 person-years with 95% confidence intervals and the incidences were compared by incidence rate ratios (IRR), including age, diagnosis, and gender stratified analyses. RESULTS A total of 71,972 patients were included with 76,785 ED visits or hospitalizations for pTBI diagnoses. The annual incidence of diagnosed pTBI was 251 (CI: 241-260) per 100,000 in 1998 and 547 (CI: 533-561) per 100,000 in 2018, indicating a 118% increase in the incidence (IRR 2.18 CI: 2.09-2.28). Boys had 32% higher incidence (IRR 1.32 CI: 1.30-1.34) than girls. The highest cumulative incidence was observed among boys aged <1 years, 525 (CI: 507-543) per 100,000, and boys had higher incidences in all age groups. The most used diagnostic code was concussion, which included 92.1% of the diagnoses followed by diffuse brain injury, which included 2.3% of the diagnoses. The increase in the incidence of diagnosed pTBI was notably high after 2010. Concussion diagnoses and pTBI cases that were discharged directly from the ED had more than a two-fold increase from 2010 to 2018, whereas the incidence of inpatient admissions for pTBI increased by 53%. CONCLUSIONS The overall incidence of diagnosed pTBI has increased in Finland especially since 2010. Boys have higher incidence of diagnosed pTBI in all age groups. Most of the increase was due to increase in the concussion diagnoses, which may be due to the centralization of EDs into bigger units and increased diagnostic awareness of mild pTBI.
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Affiliation(s)
- Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland.
| | | | - Grant L Iverson
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Boston, MA, United States of America; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, Massachusetts, United States of America
| | - Harri Isokuortti
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland; Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
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Postconcussion Symptom Catastrophizing Scale: Preliminary Reliability and Validity Analysis of Cross-sectional Data. Am J Phys Med Rehabil 2023; 102:105-109. [PMID: 35473889 DOI: 10.1097/phm.0000000000002040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of the study was to describe cross-sectional relationships between postconcussion symptom catastrophizing and patient-level factors in a postconcussion cohort. DESIGN This cross-sectional study was conducted in an outpatient rehabilitation hospital concussion clinic and consisted of adults undergoing a neuropsychological evaluation. Cronbach α assessed internal consistency for Post-Concussion Symptom Catastrophizing Scale total scores. Pearson r correlation coefficients assessed construct validity among emotional function measures and Post-Concussion Symptom Catastrophizing Scale total scores at initial evaluation. Hierarchical regression models were used to assess criterion validity. RESULTS Excellent internal consistency was observed for Post-Concussion Symptom Catastrophizing Scale total scores (α = 0.953). The Post-Concussion Symptom Catastrophizing Scale was significantly correlated with cause of injury ( r = -0.223, P < 0.01), litigation consideration ( r = 0.309, P < 0.05), and history of psychiatric illness ( r = 0.198, P < 0.01). The Post-Concussion Symptom Catastrophizing Scale was significantly correlated with emotional functioning (Patient Health Questionnaire [ r = 0.600, P < 0.05]; Generalized Anxiety Disorder [ r = 0.602, P < 0.05]), symptom rating (Sports Concussion Assessment Tool [Fifth Edition, r = 0.477, P < 0.05]), and cognitive functioning (Repeatable Battery for the Assessment of Neuropsychological Status [ r = -0.238, P < 0.05]) measures. The final regression model explained 64.7% variance in Post-Concussion Symptom Catastrophizing Scale total scores and included the Generalized Anxiety Disorder ( b = 1.038, β = 0.466, P = 0.001) as a unique predictor. CONCLUSIONS Results indicate strong, positive relationships between anxiety and catastrophizing at initial neuropsychological evaluation in a postconcussion sample.
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Barber KR, Wasfie T. Inpatient management of complicated mTBI with the BIG assessment tool: Review and summary of the evidence. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086221148560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction The management of mild traumatic brain injury has evolved through the years with an emphasis on the safe discharge of patients given current resources. In this article, we discuss key studies published in the past 12 years that have influenced the direction of complicated mild traumatic brain injury (cmTBI) management. We summarize the evidence on the utilization of the Brain Injury Guideline (BIG) algorithm. Methods An independent literature search was conducted on the BIG, updated versions of BIG, and the prognostic studies of adult mild traumatic brain injury admissions cited by the BIG articles. Evidence resources included the search engines of PubMed, Medline, Ovid, Cochrane Library, and Google Scholar bibliographic databases of items published between 1 January 2010 and 30 December 2021. The evidence focused on BIG and its modified versions, as a potential risk assessment tool for discharging mTBI patients early. Results Studies supporting the BIG algorithm prior to 2019 presented evidence with serious limitations to their findings. These limitations threaten their veracity and fail to support the efficacy or validation of the BIG algorithm's utilization for mTBI patient management. Conclusion The lack of rigor in the BIG algorithm studies suggest the research is currently insufficient to support early discharge and research needs to continue on modified versions of the tool before its widespread use.
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Affiliation(s)
| | - Tarik Wasfie
- Trauma Department, Ascension Genesys, Grand Blanc, MI, USA
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Sheeba S, Cavaleri R, Summers S, Browne C. Effectiveness of non-pharmacological treatments for vestibular and oculomotor dysfunction in patients with persistent post-concussive symptoms: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e066634. [PMID: 36609322 PMCID: PMC9827270 DOI: 10.1136/bmjopen-2022-066634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Concussion is a form of mild traumatic brain injury that disrupts brain function. Although symptoms are mostly transient, recovery can be delayed and result in persistent postconcussive symptoms (PPCS). Vestibular and oculomotor dysfunction are among the most debilitating impairments associated with PPCS. However, pharmacological interventions for these impairments are associated with deleterious side effects. Accordingly, increasing research has examined the utility of non-pharmacological interventions for PPCS. The aim of this review is to synthesise and evaluate the effectiveness of non-pharmacological interventions for the treatment of vestibular and oculomotor dysfunction for patients with PPCS. METHODS AND ANALYSIS Systematic searches of MEDLINE, PubMed, Web of Science and Scopus will identify randomised controlled trials employing non-pharmacological treatments for vestibular and/or oculomotor dysfunction for PPCS. Such interventions may include, but are not limited to, vestibular rehabilitation, optokinetic stimulation and vestibulo-ocular reflex exercises. Assessments of oculomotor function will include versional eye movements, vergence eye movements, visual-fixation movements and accommodation response. Assessments of vestibular function will include the Fukuda Step test, functional balance tests, force displacement tests, and subjective reports of balance disruption or vertigo. Where appropriate, meta-analyses of standardised mean differences will be conducted using a random effects model for continuous outcomes. For dichotomous outcomes (improved vs not improved following treatment), effects will be expressed as relative risk. The impact of heterogeneity will be calculated using the I2 statistic. The Physiotherapy Evidence Database scale will be used to determine the methodological quality of individual studies and Grading of Recommendations, Assessment, Development and Evaluations used to assess the certainty and quality of evidence for each outcome. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021254720.
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Affiliation(s)
- Stella Sheeba
- School of Science, Western Sydney University, Sydney, New South Wales, Australia
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Rocco Cavaleri
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Simon Summers
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Cherylea Browne
- School of Science, Western Sydney University, Sydney, New South Wales, Australia
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Translational Neuroscience Facility, UNSW Sydney, Sydney, New South Wales, Australia
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Laskosky NA, Huston P, Lam WC, Anderson C, Zheng Y, Zhong LLD. Are tai chi and qigong effective in the treatment of TBI? A systematic review protocol. Front Aging Neurosci 2023; 15:1121064. [PMID: 36949776 PMCID: PMC10025504 DOI: 10.3389/fnagi.2023.1121064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/20/2023] [Indexed: 03/08/2023] Open
Abstract
Background Traumatic brain injury (TBI) adversely affects both young and old and is a growing public health issue. A number of recent trends in managing TBI, such as recommending sub-threshold aerobic activity, tailoring multi-modal treatment strategies, and studying the possible role of low-grade inflammation in those with persistent symptoms, all suggest that the physical and cognitive exercise of tai chi/qigong could have benefit. Method Designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the following databases will be searched: MEDLINE, CINAHL, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. All clinical trials on mild, moderate and/or severe TBI with tai chi and/or qigong as the treatment group and any comparison group, in any setting will be included. Four reviewers will independently select studies; two reviewers for the English and two for the Chinese databases. Cochrane-based risk of bias assessments will be conducted on all included studies. An analysis will then be conducted with the grading of recommendation, assessment, development, and evaluation (GRADE) instrument. Results This review will summarize the clinical trial evidence on tai chi/qigong for TBI including type of TBI, age/sex of participants, type and length of intervention and comparator, outcome measures, and any adverse events. The risk of bias will be considered, and the strengths and weaknesses of each trial will be analyzed. Discussion The results of this review will be considered with respect to whether there is enough evidence of benefit to merit a more definitive randomized controlled trial.Systematic Review Registration: PROSPERO [CRD42022364385].
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Affiliation(s)
- Nicole Alexandra Laskosky
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Nicole Alexandra Laskosky,
| | - Patricia Huston
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort (Research), University of Ottawa, Ottawa, ON, Canada
| | - Wai Ching Lam
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Ya Zheng
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Linda L. D. Zhong
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
- *Correspondence: Linda L. D. Zhong,
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Galea O, O'Leary S, Treleaven J. An Investigation of Physiological System Impairments in Individuals 4 Weeks to 6 Months Following Mild Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:E79-E87. [PMID: 35617655 DOI: 10.1097/htr.0000000000000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The Buffalo Concussion Treadmill Test (BCTT) was developed to identify potential physiological system impairment (PSI) underlying persistent symptoms post-mild traumatic brain injury (mTBI). This study evaluates PSI in individuals 4 weeks to 6 months post-mTBI using the BCTT "failure" criteria, and additional exploratory measures of test duration and heart rate (HR) response. SETTING Tertiary hospital and university. PARTICIPANTS Participants included 73 individuals 4 weeks to 6 months post-mTBI and a comparison group of 39 healthy controls (HCs). The mTBI group was further subgrouped at screening into those considering themselves asymptomatic (Asymp mTBI) ( n = 35) or symptomatic (Symp mTBI) ( n = 36). DESIGN Observational cohort study. MAIN MEASURES BCTT; failure rate (%), test duration (minutes), HR responses. RESULTS : Thirty percent of the mTBI group (including 50% of the Symp and 9% of the Asymp subgroups) failed the BCTT. BCTT duration and associated overall HR change was significantly lower in the mTBI group and Symp subgroup compared with HCs. Compared with HCs maximal HR percentage was higher for the first 4 minutes of the test in the mTBI group, and for the first 2 minutes of the test for the Symp subgroup. CONCLUSIONS Individuals post-mTBI demonstrated PSI impairment subacutely. In some individuals this was despite an initially reported absence of symptoms. The study also showed some preliminary evidence that BCTT duration and HR responses may be additionally informative post-mTBI.
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Affiliation(s)
- Olivia Galea
- Neck and Head Research Unit, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia (Drs Galea, O'Leary, and Treleaven); and Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia (Dr O'Leary)
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Ross EA, Hines RB, Hoffmann M, Jay K, Antonucci MM. Multi-Modal Neurorehabilitation for Persisting Post-Concussion Symptoms. Neurotrauma Rep 2023; 4:297-306. [PMID: 37187507 PMCID: PMC10181800 DOI: 10.1089/neur.2022.0081] [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] [Indexed: 05/17/2023] Open
Abstract
Treatment of the chronic sequela that persist after a mild traumatic brain injury has been challenging with limited efficacy. The aim of this work was to report outcomes obtained from persons who met the criteria of persisting post-concussive symptoms (PPCS), utilizing a novel combination of modalities in a structured neurorehabilitation program. This work was designed as a retrospective, pre-post chart review of objective and subjective measures collected from 62 outpatients with PPCS a mean of 2.2 years post-injury, before and after a multi-modal 5-day treatment protocol. The subjective outcome measure was the 27-item modified Graded Symptom Checklist (mGSC). Objective outcome measures were motor speed/reaction time, coordination, cognitive processing, visual acuity, and vestibular function. Interventions included non-invasive neuromodulation, neuromuscular re-education exercises, gaze stabilization exercises, orthoptic exercises, cognitive training, therapeutic exercises, and single/multi-axis rotation therapy. Pre-post differences in measures were analyzed using the Wilcoxon signed-rank test, with effect size determined by the rank-biserial correlation coefficient. Pre-post treatment comparisons for the subjective mGSC overall, combined symptom measures, individual components of the mGSC, and cluster scores significantly improved for all items. Moderate strength relationships were observed for the mGSC composite score, number of symptoms, average symptom score, feeling in a "fog," "don't feel right," irritability, and physical, cognitive, and affective cluster scores. Objective symptom assessment significantly improved for trail making, processing speed, reaction time, visual acuity, and Standardized Assessment of Concussion. Patients suffering from PPCS ∼2 years after injury may have significant benefits with some moderate effect sizes from an intensive, multi-modal neurorehabilitation program.
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Affiliation(s)
- Edward A. Ross
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
- Address correspondence to: Edward A. Ross, MD, Department of Medicine, University of Central Florida, 6850 Lake Nona Boulevard, Orlando, FL 32832, USA
| | - Robert B. Hines
- Department of Population Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Michael Hoffmann
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
- Neurology Section, Orlando VA Medical Center, Orlando, Florida, USA
| | - Kenneth Jay
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
- Department of Neurology, Carrick Institute, Cape Canaveral, Florida, USA
- Department of Research, Cervello, A/S, Roskilde, Denmark
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Chan V, Estrella MJ, Baddeliyanage R, Shah R, Babineau J, Colantonio A. Rehabilitation among individuals experiencing homelessness and traumatic brain injury: A scoping review. Front Med (Lausanne) 2022; 9:916602. [PMID: 36438043 PMCID: PMC9692012 DOI: 10.3389/fmed.2022.916602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 10/24/2022] [Indexed: 09/19/2023] Open
Abstract
Traumatic brain injury (TBI) is disproportionately prevalent among individuals experiencing homelessness. While rehabilitation is critical to facilitating recovery after TBI, there is currently limited information on the extent to which rehabilitation is provided to individuals experiencing homelessness and TBI. If unaddressed, this knowledge gap can perpetuate TBI-related challenges and contribute to a repetitive cycle of TBI and homelessness. This scoping review explored the extent to which rehabilitation, including the types of rehabilitation interventions, are available to, or used by, individuals experiencing homelessness and TBI. A systematic search of electronic databases (MEDLINE, Embase, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, and Proquest Nursing and Allied Health) was conducted to identify peer-reviewed articles that met predetermined eligibility criteria. Gray literature and reference lists of eligible articles were also searched for relevant content. A descriptive numerical summary of extracted data was conducted, and qualitative analytic techniques were applied to analyze the data. Fifteen peer-reviewed articles and three gray literature reports were included, describing interventions for individuals experiencing homelessness and TBI (N = 4), rehabilitation for individuals experiencing homelessness without specific inclusion criteria for TBI (N = 11), and rehabilitation interventions that included individuals experiencing homelessness and TBI, without specific inclusion criteria for experiences of homelessness or TBI (N = 3). This review demonstrates that rehabilitation programs or interventions for this population already exist, and those that are focused on individuals experiencing homelessness are already serving individuals with TBI. Findings highlight opportunities to adapt existing rehabilitation for individuals who experience homelessness and TBI through screening for TBI, conducting cognitive and functional assessments, and tailoring interventions with multidisciplinary teams. Education and training for healthcare professionals working with individuals experiencing homelessness and TBI should be explored, including structured education and training, collaboration with a multidisciplinary team, and co-development of educational materials with service users. Research that considers the rehabilitation needs of diverse individuals experiencing homelessness and TBI is urgently needed.
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Affiliation(s)
- Vincy Chan
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maria Jennifer Estrella
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | | | - Riya Shah
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Angela Colantonio
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Vuu S, Barr CJ, Killington M, Jill G, van den Berg ME. Physical exercise for people with mild traumatic brain injury: A systematic review of randomized controlled trials. NeuroRehabilitation 2022; 51:185-200. [DOI: 10.3233/nre-220044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Recent research recommends physical exercise rather than rest following a mild traumatic brain injury (mTBI). OBJECTIVE: To determine the effect of physical exercise on persistent symptoms in people with mTBI. METHODS: A search of randomized controlled trials was conducted in CINAHL, Cochrane Library, EMBASE, MEDLINE, SportDiscus and Web of Science, from 2010 to January 2021. Studies were included if they described the effects of a physical exercise intervention in people with mTBI on persistent symptoms. Study quality, intervention reporting, and confidence in review findings were assessed with the CASP, TIDieR and GRADE respectively. RESULTS: 11 eligible studies were identified for inclusion. Study interventions broadly comprised of two categories of physical exercise, i.e., aerobic (n = 8) and vestibular (n = 3). A meta-analysis (n = 3) revealed the aerobic exercise group improvement was significantly larger compared to the usual care group –0.39 (95% CI: –0.73 to –0.05, p = 0.03). Only three studies using vestibular exercise reported on persistent symptoms and yielded mixed results. CONCLUSIONS: This study demonstrated that the use of aerobic exercise is supported by mixed quality evidence and moderate certainty of evidence, yet there is limited evidence for the use of vestibular exercise for improving persistent symptoms in people with mTBI.
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Affiliation(s)
- Sally Vuu
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Christopher J. Barr
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Maggie Killington
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Garner Jill
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Cheng Y, Zhang Y, Zhang Y, Wu YH, Zhang S. Reliability and validity of the Rowland Universal Dementia Assessment Scale for patients with traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:1160-1166. [PMID: 33321049 DOI: 10.1080/23279095.2020.1856850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following traumatic brain injury (TBI). The aim of this study was to evaluate the reliability and validity of the Rowland Universal Dementia Assessment Scale (RUDAS) for TBI and to verify the clinical application value. Fifty patients with TBI and 32 matched controls were assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a newly developed Chinese version of RUDAS. These scales were then compared for internal consistency, inter-rater reliability, test‒retest reliability, content validity, construct validity, and diagnostic efficacy. Among the TBI group, the RUDAS demonstrated acceptable internal consistency (Cronbach's α = 0.733), high inter-rater reliability (intraclass correlation coefficients [ICCs] of 0.910‒0.999), and high test‒retest reliability (total score ICC = 0.938). The correlation coefficients between RUDAS total score and individual subscores were all > 0.5 except for body orientation (r = 0.363), indicating generally good content validity. Total RUDAS scores were moderately correlated with both MMSE total scores (r = 0.701, p < 0.001) and MoCA total scores (r = 0.778, p < 0.001), indicating good construct validity. Receiving operating characteristic curve analysis yielded comparable areas under the curve for diagnostic efficacy (RUDAS, 0.844; MMSE, 0.769; MoCA, 0.824; all p > 0.05). A RUDAS score cutoff of 23.5 distinguished TBI patients from controls with 60% sensitivity and 100% specificity. Therefore, the RUDAS demonstrates both good reliability and validity for evaluating cognitive impairments in TBI patients.
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Affiliation(s)
- Yun Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ye-Huan Wu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shuang Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
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A Case Series of 39 United States Veterans with Mild Traumatic Brain Injury Treated with Hyperbaric Oxygen Therapy. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6030021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Importance: The Defense and Veterans Brain Injury Center reported 358,088 mild traumatic brain injury (mTBI) among U.S. service members worldwide between the years 2000 and 2020. Veterans with mTBI have higher rates of Post-Traumatic Stress Disorder (PTSD), depressive disorder, substance use disorder, anxiety disorder, and suicide than their healthy counterparts. Currently, there is no effective treatment for mTBI. Objective: To assess the efficacy of hyperbaric oxygen therapy (HBOT) as a treatment option for mTBI. Design, Setting, Participants: This is a case series of 39 U.S. Veterans diagnosed with mTBI and treated with HBOT. Of these participants, 36 were men and 3 women, and their ages ranged between 28 and 69. The treatment was administered by The 22 Project (a veteran-centered nonprofit organization) using monoplace hyperbaric chambers located in Delray Beach, Florida. Neuroimaging using Single Photon Emission Computer Tomography (SPECT) brain scans performed pre- and post-HBOT were made available for secondary analysis. Nilearn Python Library was utilized to visualize the corresponding neuroimaging data. A two-sided paired t-test in R was used to compare the pre- and post-treatment results. Intervention: A full treatment of HBOT involved 40 sessions. Each session consisted of the administration of 100% oxygen at 1.5 atmospheres for 90 min, twice a day, for 20 days, Mondays to Fridays only. Main Outcome and Measure: Perfusion in the brain’s Brodmann Areas (BA) comparing pre- and post-HBOT using NeuroGam software analysis from brain SPECT scan neuroimaging and multi-symptom self-reports. Results: A comparison between the pre- and post-HBOT brain scans showed significant improvement in the brain perfusion, and the difference was statistically significant (p < 0.001). Separately, participants reported reduced pain, improved mood, and better sleep, an outcome that translated into an average of about 46.6% improvement in the measured symptoms. Conclusions and Relevance: This series demonstrated that HBOT could be a useful treatment for mTBI in U.S. veterans. The participants in the study showed marked improvement in both brain perfusion measured on SPECT scan imaging and measured mTBI symptoms. This is the first study to use brain SPECT scans with quantitative numerical measurements to demonstrate improvement in brain perfusion in veterans with mild TBI treated with HBOT and measured mTBI symptoms. Future research studies are currently being done to validate these important findings.
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Alnawmasi MM, Khuu SK. Deficits in multiple object-tracking and visual attention following mild traumatic brain injury. Sci Rep 2022; 12:13727. [PMID: 35962018 PMCID: PMC9374772 DOI: 10.1038/s41598-022-18163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Difficulty in the ability to allocate and maintain visual attention is frequently reported by patients with traumatic brain injury (TBI). In the present study, we used a multiple object tracking (MOT) task to investigate the degree to which TBI affects the allocation and maintenance of visual attention to multiple moving targets. Fifteen adults with mild TBI and 20 control participants took part in this study. All participants were matched for age, gender, and IQ. The sensitivity and time taken to perform the MOT task were measured for different conditions in which the duration of the tracking, number of target, and distractor dots were systematically varied. When the number of target dots required to be tracked increased, sensitivity in correctly detecting them decreased for both groups but was significantly greater for patients with mild TBI. Similarly, increasing the number of distractor dots had a greater effect on reducing task sensitivity for patients with mild TBI than control participants. Finally, across all conditions, poorer detection performance was observed for patients with mild TBI when the tracking duration was longer compared to control participants. The present study showed that patients with mild TBI have greater deficits (compared to control participants) in their ability to maintain visual attention on tracking multiple moving objects, which was particularly hindered by increased tracking load and distraction.
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Affiliation(s)
- Mohammed M Alnawmasi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia. .,College of Applied Medical Science, Department of Optometry, Qassim University, Buraydah, Saudi Arabia.
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Xiang L, Bansal S, Wu AY, Roberts TL. Pathway of care for visual and vestibular rehabilitation after mild traumatic brain injury: a critical review. Brain Inj 2022; 36:911-920. [PMID: 35918848 PMCID: PMC10134507 DOI: 10.1080/02699052.2022.2105399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PRIMARY OBJECTIVE To review the pathway to care for treatment and management of patients receiving visual and vestibular rehabilitation after mild traumatic brain injury (mTBI). METHODS & PROCEDURES English scientific peer-reviewed articles from PubMed, CINAHL, Embase, and PsycINFO between 2000 and 2020 were first screened by title and abstract, then those selected underwent full-text review and analysis. MAIN OUTCOMES & RESULTS The database search yielded 1640 results and after title and abstract review, 75 articles were selected for full-text screening, from which 8 were included in the qualitative synthesis. Current evidence includes a limited number of retrospective cohort studies and case studies. CONCLUSIONS Many patients with visual and vestibular deficits following mTBI do not receive rehabilitation services until months following their injury as there is no standardized pathway to care for patients for visual and vestibular rehabilitation. Barriers to establishing a standardized pathway are the lack of natural history data for visual and vestibular function following mTBI and the lack of randomized clinical trials establishing the efficacy of rehabilitation in patients following mTBI.
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Affiliation(s)
- Lucille Xiang
- School of Physical and Occupational Therapy, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada.,School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Surbhi Bansal
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - Albert Y Wu
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute at Stanford University, Palo Alto, California, USA
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McCann R, Schussler E, Martinez J, Ramirez V. The Effect of Concussion History on Lower Extremity Injury Risk in College Athletes: A Systematic Review and Meta-Analysis. Int J Sports Phys Ther 2022; 17:753-765. [PMID: 35949388 PMCID: PMC9340842 DOI: 10.26603/001c.36810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Collegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury. Objective To conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes. Methods A literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, ["concussion" OR "brain injury" OR "mild traumatic brain injury" OR "mTBI"] AND ["lower extremity injury" OR "musculoskeletal injury"]. Articles were included if they were published between January 2000 and July 2021 and examined collegiate athletes' risk of sustaining a lower extremity musculoskeletal injury following a concussion. Methodological quality of included studies was performed with a modified Downs and Black Checklist. The primary outcome of interest was the risk of sustaining a lower extremity musculoskeletal injury following a concussion. A random effects meta-analysis was conducted in which a summative relative risk (RR) for sustaining a lower extremity injury in athletes with and without a history of concussion was calculated. Results Seven studies met the eligibility criteria to be included in the systematic review. There were 348 athletes in the concussion group and 482 control athletes in the included studies. Most of the studies were of good or excellent quality. Five of the seven studies were able to be included in the meta-analysis. College athletes who suffered a concussion possessed a 58% greater risk of sustaining a lower extremity musculoskeletal injury than those who did not have a history of a concussion (RR = 1.58[1.30, 1.93]). Conclusions Lower extremity injury risk is potentially increased in college athletes following a concussion compared to those without a history of a concussion. Further research is needed to investigate the mechanism behind this increased risk. Clinical assessments throughout the concussion return-to-play protocol may need to be improved in order to detect lingering impairments caused by concussions. Level of Evidence 1.
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Affiliation(s)
- Ryan McCann
- Rehabilitation Sciences, Old Dominion University
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Næss-Schmidt ET, Thastum MM, Stabel HH, Odgaard L, Pedersen AR, Rask CU, Silverberg ND, Schröder A, Nielsen JF. Interdisciplinary intervention (GAIN) for adults with post-concussion symptoms: a study protocol for a stepped-wedge cluster randomised trial. Trials 2022; 23:613. [PMID: 35906645 PMCID: PMC9338593 DOI: 10.1186/s13063-022-06572-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Persistent post-concussion symptoms (PCS) are associated with prolonged disability, reduced health-related quality of life and reduced workability. At present, no strong evidence for treatments for people with persistent PCS exists. Our research group developed a novel intervention, “Get going After concussIoN (GAIN)”, that incorporates multiple evidence-based strategies including prescribed exercise, cognitive behavioural therapy, and gradual return to activity advice. In a previous randomised trial, GAIN provided in a hospital setting was effective in reducing symptoms in 15–30-year-olds with PCS 2–6 months post-injury. In the current study, we describe the protocol for a trial designed to test the effectiveness of GAIN in a larger municipality setting. Additionally, we test the intervention within a broader age group and evaluate a broader range of outcomes. The primary hypothesis is that participants allocated to enhanced usual care plus GAIN report a higher reduction in PCS 3 months post-intervention compared to participants allocated to enhanced usual care only. Methods The study is a stepped-wedge cluster-randomised trial with five clusters. The 8-week interdisciplinary GAIN program will be rolled out to clusters in 3-month intervals. Power calculation yield at least 180 participants to be enrolled. Primary outcome is mean change in PCS measured by the Rivermead Post-Concussion Symptoms Questionnaire from enrolment to 3 months after end of treatment. Secondary outcomes include participation in and satisfaction with everyday activities, labour market attachment and other behavioural measures. Self-reported outcomes are measured at baseline, by end of treatment and at 3, 6, and 18 months after end of treatment. Registry-based outcomes are measured up to 36 months after concussion. Discussion The trial will provide important information concerning the effectiveness of the GAIN intervention in a municipality setting. Furthermore, it will provide knowledge of possible barriers and facilitators that may be relevant for future implementation of GAIN in different settings. Trial registration The current GAIN trial is registered in ClinicalTrials.gov (study identifier: NCT04798885) on 20 October 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06572-7.
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Affiliation(s)
- Erhard Trillingsgaard Næss-Schmidt
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark. .,Department of Clinical Medicine, AU, Aarhus, Denmark.
| | - Mille Møller Thastum
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark
| | - Henriette Holm Stabel
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark
| | - Lene Odgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark
| | - Asger Roer Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, AU, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Clinical Medicine, AU, Aarhus, Denmark.,Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Andreas Schröder
- Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, AU, Aarhus, Denmark
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Vychopen M, Hamed M, Bahna M, Racz A, Ilic I, Salemdawod A, Schneider M, Lehmann F, Eichhorn L, Bode C, Jacobs AH, Behning C, Schuss P, Güresir E, Vatter H, Borger V. A Validation Study for SHE Score for Acute Subdural Hematoma in the Elderly. Brain Sci 2022; 12:981. [PMID: 35892422 PMCID: PMC9330492 DOI: 10.3390/brainsci12080981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The aim of this study was the verification of the Subdural Hematoma in the Elderly (SHE) score proposed by Alford et al. as a mortality predictor in patients older than 65 years with nontraumatic/minor trauma acute subdural hematoma (aSDH). Additionally, we evaluated further predictors associated with poor outcome. METHODS Patients were scored according to age (1 point is given if patients were older than 80 years), GCS by admission (1 point for GCS 5-12, 2 points for GCS 3-4), and SDH volume (1 point for volume 50 mL). The sum of points determines the SHE score. Multivariate logistic regression analysis was performed to identify additional independent risk factors associated with 30-day mortality. RESULTS We evaluated 131 patients with aSDH who were treated at our institution between 2008 and 2020. We observed the same 30-day mortality rates published by Alford et al.: SHE 0: 4.3% vs. 3.2%, p = 1.0; SHE 1: 12.2% vs. 13.1%, p = 1.0; SHE 2: 36.6% vs. 32.7%, p = 0.8; SHE 3: 97.1% vs. 95.7%, p = 1.0 and SHE 4: 100% vs. 100%, p = 1.0. Additionally, 18 patients who developed status epilepticus (SE) had a mortality of 100 percent regardless of the SHE score. The distribution of SE among the groups was: 1 for SHE 1, 6 for SHE 2, 9 for SHE 3, and 2 for SHE 4. The logistic regression showed the surgical evacuation to be the only significant risk factor for developing the seizure. All patients who developed SE underwent surgery (p = 0.0065). Furthermore, SHE 3 and 4 showed no difference regarding the outcome between surgical and conservative treatment. CONCLUSIONS SHE score is a reliable mortality predictor for minor trauma acute subdural hematoma in elderly patients. In addition, we identified status epilepticus as a strong life-expectancy-limiting factor in patients undergoing surgical evacuation.
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Affiliation(s)
- Martin Vychopen
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Majd Bahna
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Attila Racz
- Department of Epileptology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Inja Ilic
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Abdallah Salemdawod
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Felix Lehmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (F.L.); (L.E.); (C.B.)
| | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (F.L.); (L.E.); (C.B.)
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany; (F.L.); (L.E.); (C.B.)
| | - Andreas H. Jacobs
- Department of Geriatric Medicine and Neurology, Johanniter Hospital Bonn, 53113 Bonn, Germany;
| | - Charlotte Behning
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany; (M.H.); (M.B.); (I.I.); (A.S.); (M.S.); (P.S.); (E.G.); (H.V.); (V.B.)
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Outlining the Invisible: Experiences and Perspectives Regarding Concussion Recovery, Return-to-Work, and Resource Gaps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138204. [PMID: 35805862 PMCID: PMC9266414 DOI: 10.3390/ijerph19138204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 02/01/2023]
Abstract
Appropriate supports and accommodations are necessary to ensure full concussion recovery and return-to-work (RTW). This research investigated barriers and facilitators to concussion recovery and RTW, and resource gaps reported by adults with concussion (‘workers’) and workplace and healthcare professionals (‘workplaces’). Semi-structured interviews and focus groups were conducted with workers (n = 31) and workplaces (n = 16) across British Columbia. Data were analyzed using inductive content analysis. Facilitators to workers’ concussion recovery and RTW included treatment, social support, and workplace and lifestyle modifications. To address barriers, both groups recommended: (a) widespread concussion and RTW education and training (b) standardized concussion recovery guidelines; (c) changing attitudes toward concussion; (d) mental health supports; and (e) increasing awareness that every concussion is unique. Findings can inform best practice for concussion recovery and RTW among professionals in workplaces, healthcare, occupational health and safety, and workers’ compensation boards.
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Moen E, McLean A, Boyd LA, Schmidt J, Zwicker JG. Experiences of Children and Youth With Concussion: A Qualitative Study. Am J Occup Ther 2022; 76:23301. [PMID: 35709001 DOI: 10.5014/ajot.2022.047597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Concussions are common among children and youth. To date, the pediatric concussion literature has focused on quantitative reports of the effects of concussion and return-to-activity guidelines. However, the subjective experiences of children and youth returning to occupations postconcussion have largely been ignored. An understanding of these experiences is critical to inform effective concussion management. OBJECTIVE To investigate the experiences of children and youth returning to occupations after sustaining a concussion and the impacts on their future engagement in occupation. DESIGN Qualitative interpretive description was used for data analysis and interpretation. SETTING Community. PARTICIPANTS Children and youth ages 11 to 18 yr from a cohort study were recruited to be interviewed about their experiences of engaging in occupations postconcussion. OUTCOMES AND MEASURES Interviews were conducted 3 to 24 mo postconcussion, transcribed verbatim, and analyzed using interpretive description to identify themes. RESULTS Eight children and youth (5 male, 3 female) were included. Analyses revealed three themes of the experiences of children and youth returning to occupations after concussion: diverse experiences of concussion, knowledge is key to concussion management, and concussions affect occupational engagement. CONCLUSIONS AND RELEVANCE This study highlights the importance of considering a person's needs to enable effective concussion treatment plans. The results suggest the need for an occupation-based framework to guide interventions in pediatric concussion management. What This Article Adds: Our findings indicate that children and youth report variable recovery patterns, a lack of knowledge about concussion recovery, and a negative effect of concussion on occupational engagement.
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Affiliation(s)
- Emily Moen
- Emily Moen, BSc, MOT, is Occupational Therapist, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alison McLean
- Alison McLean, BSc, MOT, is Occupational Therapist, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lara A Boyd
- Lara A. Boyd, PT, PhD, is Professor, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia Schmidt
- Julia Schmidt, BSc(OT), PhD, is Assistant Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada, and xxx, GF Strong Rehabilitation Research Program, Vancouver, British Columbia, Canada;
| | - Jill G Zwicker
- Jill G. Zwicker, MA, PhD, BSc, BA, OT(C), is Associate Professor, Department of Occupational Science and Occupational Therapy and Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Investigator, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; and Clinician Scientist, Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
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Šarkić B, Douglas JM, Simpson A. 'I had nothing. It's just life experience that helped me through that situation': Australian audiologists' perspectives on audiological clinical practice for traumatic brain injury and rehabilitation. Brain Inj 2022; 36:886-897. [PMID: 35758048 DOI: 10.1080/02699052.2022.2092651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Australian Audiologists' perspectives on standard non-specialized clinical practice in the context of Traumatic Brain Injury (TBI) were examined, including the perceived barriers to optimal service provision. DESIGN A qualitative research design utilizing semi-structured interviews was conducted using purposive sampling. Nine participants were interviewed about their understanding of the impact of TBI on hearing and balance; identification, diagnosis and management of auditory and vestibular dysfunction following TBI; barriers to service delivery; training relating to complex clients (i.e., TBI); and awareness of referral pathways. RESULTS Three major themes, each with subthemes, were evident in the data. The major themes reflected general considerations of audiological professional culture and specific issues related to knowledge of TBI and clinical practice with patients. Analysis revealed that professional culture seemed to act as a contextual barrier and interacted with the perceived lack of TBI related knowledge to hinder optimal clinical practice in this patient population. CONCLUSION Application of the biopsychosocial model, including interdisciplinary care in the management of patients with TBI, is needed. An improvement in theoretical and practical knowledge encompassing the wide-ranging effects of TBI is critical for the optimal audiological service delivery.
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Affiliation(s)
- Bojana Šarkić
- Discipline of Audiology, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Jacinta M Douglas
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,Summer Foundation, Melbourne, Australia
| | - Andrea Simpson
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.,College of Health and Human Services, Charles Darwin University, Darwin, Australia
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Nanwa N, Wong V, Thompson AMS. Impact of Timing of Mental Health Interventions for Mild Traumatic Brain Injury Patients: A 10-year Matched Cohort Study of Workers' Compensation Claims. J Occup Environ Med 2022; 64:458-464. [PMID: 35761423 DOI: 10.1097/jom.0000000000002512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of timing of mental health interventions in workers' compensation claims for mild traumatic brain injury (MTBI). METHODS A 10-year matched retrospective cohort study of MTBI claims. Cases who started treatment within 3 months of the date of injury were hard matched to cases who started treatment more than 3 months after the date of injury. Outcomes were incremental cost difference and loss of earnings benefit duration 1 year after first intervention. RESULTS Seventeen percent (17%) of patients received mental health interventions. The early mental health intervention group had lower mean costs (incremental difference$1580 [95% CI: $5718 to $2085]) and shorter durations of disability (off loss of earnings) (59.2% versus 46.6%, NS). Sensitivity and stratified analyses demonstrated the same trend. CONCLUSIONS Early mental health interventions for MTBI patients may lead to reduced health care costs and shorter durations of disability.
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Affiliation(s)
- Natasha Nanwa
- From the Workplace Safety and Insurance Board, Ontario, Canada (Dr Nanwa, Dr Wong, Dr Thompson), Faculty of Medicine, University of Toronto, Ontario Canada (Dr Thompson), Dalla Lana School of Public Health, University of Toronto, Ontario, Canada (Dr Thompson)
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Kaae C, Cadigan K, Lai K, Theis J. Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review. NeuroRehabilitation 2022; 50:279-296. [DOI: 10.3233/nre-228012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Individuals who have suffered a concussion/mild traumatic brain injury (mTBI) frequently report symptoms associated with vestibular and/or oculomotor dysfunction (VOD) like dizziness, nausea, fatigue, brain fog, headache, gait and neurocognitive impairments which are associated with the development of chronic symptoms. The Vestibular/Ocular Motor Screening (VOMS) tool has been established as a reliable and clinically relevant complement to use alongside a battery of post-concussion tests to improve screening and referral for further evaluation and treatment of VOD. OBJECTIVES: This paper will review the pathoanatomy and symptomatology of common vestibular and oculomotor disorders after concussion, as well as the utility of the VOMS to assist in diagnosis, referral, and management. METHODS: Primary articles were identified using a search via PubMed, Google Scholar, OneSearch, and CINAHL. Search key terms were combinations of “mild traumatic brain injury” or “concussion” or “pursuit” or “accommodation” or “vergence” or “convergence insufficiency” or “saccades” or “vestibulo-ocular reflex” or “vestibular ocular motor screen” or “vestibular rehabilitation”, or “vision rehabilitation” including adult and pediatric populations that were published in print or electronically from 1989 to 2021 in English. Classic papers on anatomy of eye movements, vestibular system and pathological changes in mTBI were also included, regardless of publication date. RESULTS: Objective impairments are commonly found during testing of smooth pursuit, saccades, vergence, accommodation, vestibular ocular reflex, and visual motion sensitivity after mTBI. These deficits can be actively treated with vestibular physical therapy and oculomotor/neuro-optometric vision therapy. VOMS is an efficient and reliable tool that can be used by all healthcare and rehabilitation providers to aid in diagnosis of post-concussion VOD, to help facilitate the decision to refer for further evaluation and treatment to expedite symptomatic post-concussion recovery. CONCLUSIONS: VOD is common after concussion in acute, post-acute, and chronic phases. Once areas of impairments are identified through proper assessment, clinicians can maximize recovery by referring to vestibular physical therapy and/or neuro-optometry to design a targeted treatment program to address individual deficits.
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Affiliation(s)
- Cristen Kaae
- Kaiser Permanente Medical Center, Vallejo, CA, USA
| | | | - Katherine Lai
- Kaiser Permanente Medical Center, Oakland, CA, USA
- Herbert Wertheim School of Optometry & Vision Science at the University of California, Berkeley, CA, USA
| | - Jacqueline Theis
- Herbert Wertheim School of Optometry & Vision Science at the University of California, Berkeley, CA, USA
- Virginia Neuro-Optometry at Concussion Care Centre of Virginia, Richmond VA, USA
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Abstract
BACKGROUND: Post-traumatic headache is the most common sequela of brain injury and can last months or years after the damaging event. Many headache types are associated with visual concerns also known to stem from concussion. OBJECTIVES: To describe the various headache types seen after head injury and demonstrate how they impact or are impacted by the visual system. METHODS: We will mirror the International Classification of Headache Disorders (ICHD) format to demonstrate the variety of headaches following brain injury and relate correlates to the visual pathways. The PubMed database was searched using terms such as headache, head pain, vision, concussion, traumatic brain injury, glare, visuomotor pathways. RESULTS: Every type of headache described in the International Classification of Headache Disorders Edition III can be initiated or worsened after head trauma. Furthermore, there is very often a direct or indirect impact upon the visual system for each of these headaches. CONCLUSION: Headaches of every described type in the ICHD can be caused by brain injury and all are related in some way to the afferent, efferent or association areas of the visual system.
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Affiliation(s)
- Patrick T. Quaid
- Head of Optometry, VUE Cubed Vision Therapy Clinics, ON, Canada
- College of Optometrists of Ontario (Regulatory Body), ON, Canada
| | - Eric L. Singman
- Ophthalmology & Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Gosset A, Wagman H, Pavel D, Cohen PF, Tarzwell R, de Bruin S, Siow YH, Numerow L, Uszler J, Rossiter-Thornton JF, McLean M, van Lierop M, Waisman Z, Brown S, Mansouri B, Basile VS, Chaudhary N, Mehdiratta M. Using Single-Photon Emission Computerized Tomography on Patients With Positive Quantitative Electroencephalogram to Evaluate Chronic Mild Traumatic Brain Injury With Persistent Symptoms. Front Neurol 2022; 13:704844. [PMID: 35528740 PMCID: PMC9074759 DOI: 10.3389/fneur.2022.704844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Following mild traumatic brain injury (mTBI), also known as concussion, many patients with chronic symptoms (>3 months post injury) receive conventional imaging such as computed tomography (CT) or magnetic resonance imaging (MRI). However, these modalities often do not show changes after mTBI. We studied the benefit of triaging patients with ongoing symptoms >3 months post injury by quantitative electroencephalography (qEEG) and then completing a brain single positron emission computed tomography (SPECT) to aid in diagnosis and early detection of brain changes. Methods We conducted a retrospective case review of 30 outpatients with mTBI. The patients were assessed by a neurologist, consented, and received a qEEG, and if the qEEG was positive, they consented and received a brain SPECT scan. The cases and diagnostic tools were collectively reviewed by a multidisciplinary group of physicians in biweekly team meetings including neurology, nuclear medicine, psychiatry, neuropsychiatry, general practice psychotherapy, neuro-ophthalmology, and chiropractic providers. The team noted the cause of injury, post injury symptoms, relevant past medical history, physical examination findings, and diagnoses, and commented on patients' SPECT scans. We then analyzed the SPECT scans quantitatively using the 3D-SSP software. Results All the patients had cerebral perfusion abnormalities demonstrated by SPECT that were mostly undetectable by conventional imaging (CT/MRI). Perfusion changes were localized primarily in the cerebral cortex, basal ganglia, and cingulate cortex, and correlated with the patients' symptoms and examination findings. Qualitative and quantitative analyses yielded similar results. Most commonly, the patients experienced persistent headache, memory loss, concentration difficulties, depression, and cognitive impairment post mTBI. Because of their symptoms, most of the patients were unable to return to their previous employment and activity level. Conclusion Our findings outline the physical basis of neurological and psychiatric symptoms experienced by patients with mTBI. Increased detection of mTBI can lead to development of improved targeted treatments for mTBI and its various sequelae.
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Affiliation(s)
- Alexi Gosset
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hayley Wagman
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dan Pavel
- University of Illinois Medical Center, Chicago, IL, United States
| | - Philip Frank Cohen
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert Tarzwell
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Yin Hui Siow
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Leonard Numerow
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - John Uszler
- Faculty of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Mary McLean
- Private Practice, Toronto, ON, Canada
- The International Society of Applied Neuroimaging (ISAN), Toronto, ON, Canada
| | | | - Zohar Waisman
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephen Brown
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Behzad Mansouri
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Navjot Chaudhary
- University of Illinois Medical Center, Chicago, IL, United States
| | - Manu Mehdiratta
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- *Correspondence: Manu Mehdiratta
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