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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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2
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Campbell BP, Turk KW, Budson AE. The major challenges with pharmacologic management of chronic traumatic encephalopathy. Expert Rev Neurother 2024:1-5. [PMID: 39099111 DOI: 10.1080/14737175.2024.2387264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/29/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Brendan P Campbell
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University, Boston, MA, USA
| | - Katherine W Turk
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University, Boston, MA, USA
| | - Andrew E Budson
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Alzheimer's Disease Research Center, Boston University, Boston, MA, USA
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3
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Lujan A, Lin K. Rehabilitation of Persistent Symptoms After Concussion. Phys Med Rehabil Clin N Am 2024; 35:535-546. [PMID: 38945649 DOI: 10.1016/j.pmr.2024.02.006] [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: 07/02/2024]
Abstract
Persistent symptoms following a mild traumatic brain injury are challenging to treat and pose a significant threat to community reintegration. Early recognition and intervention play a pivotal role in preventing the development of persistent symptoms by providing education that emphasizes clear recovery expectations and the high likelihood of full symptom resolution. We recommend early development of a personalized treatment plan, offering guidance on gradual return to activity and specific symptom-targeted treatments that may incorporate both pharmacologic and nonpharmacologic interventions.
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Affiliation(s)
- Ashley Lujan
- Department of Rehabilitation Medicine, South Texas VAHCS, 7400 Merton Minter, San Antonio, TX 78229, USA.
| | - Katherine Lin
- Department of Physical Medicine and Rehabilitation, Palo Alto VAMC, 3801 Miranda Avenue, Building 500, Palo Alto, CA 94304, USA
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4
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McKee C, Matthews M, Kontos AP, Rankin A, Bleakley C. The role of concussion history and biological sex on baseline concussion clinical profile symptoms in adolescent rugby players. Ir J Med Sci 2024; 193:2061-2069. [PMID: 38526765 PMCID: PMC11294260 DOI: 10.1007/s11845-024-03677-7] [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: 11/08/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Accurate concussion monitoring requires access to preinjury baseline data. This is particularly important in adolescent athletes who have a high risk of concussion and are prone to prolonged recovery. As Rugby Union is governed by similar laws for men and women, it is also an ideal population to rigorously examine the impact of biological sex on concussion symptoms. AIMS To evaluate self-reported concussion symptoms at baseline in adolescent rugby union players, and examine if subtype-specific symptoms are affected by concussion history and biological sex. METHODS Adolescent rugby union players aged 16-18 years were recruited during the 2022-2023 playing season. Participants completed a series of questionnaires covering post-concussion symptoms, concussion clinical profiles, anxiety, depression and fear avoidance behaviours. Independent variables of interest in analysis were biological sex and concussion history. RESULTS 149 participants (75% male) were included. 42% (63/149) reported at least one previous concussion (average time since concussion: 18.7 months, range 1-72). Adolescents with a concussion history reported significantly higher scores than those with no history, across two clinical profiles (ocular and sleep), concussion symptom severity, and depression, all based on medium effect sizes (SMD 0.3-0.5). Females had significantly higher scores across cognitive/fatigue, ocular and sleep clinical profiles, concussion symptoms, anxiety and depression, each with large effect sizes (SMD > 0.5). CONCLUSIONS Concussion history and sex are associated with higher baseline scores on specific concussion clinical profile, concussion symptom severity, and anxiety symptoms. These findings highlight the importance of considering baseline differences when interpreting post-injury clinical profile symptoms in adolescent rugby players. (Trial registration: ACTRN12622000931774).
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Affiliation(s)
- Connor McKee
- Faculty of Life and Health Sciences, Ulster University, York St., Belfast, BT15 1ED, Northern Ireland
| | - Mark Matthews
- Faculty of Life and Health Sciences, Ulster University, York St., Belfast, BT15 1ED, Northern Ireland
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alan Rankin
- Sports Institute of Northern Ireland, Belfast, Northern Ireland
- Sport Medicine NI LTD, Belfast, Northern Ireland
| | - Chris Bleakley
- Faculty of Life and Health Sciences, Ulster University, York St., Belfast, BT15 1ED, Northern Ireland.
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5
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Briscoe J, Doherty J, Burgess K, Kent C. Errorful learning improves recognition memory for new vocabulary for people living with memory and dysexecutive impairment following brain injury. Neuropsychol Rehabil 2024; 34:974-1004. [PMID: 37733957 DOI: 10.1080/09602011.2023.2259017] [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: 03/13/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
A widely accepted view is that errorless learning is essential for supporting new learning in people with anterograde amnesia, but findings are mixed for those with a broader range of memory impairments. People at a chronic stage of recovery from brain injury (BI) with impaired memory and executive function (N = 26) were compared with adults in a comparison group without any known risks to brain function (N = 25). Learning techniques were compared using a "Generate-and-correct" and "Read-only" condition when learning novel word pairs. At test, both groups scored above chance and showed benefits of Generate-and-correct (errorful learning). Poor learners in the BI group were classified from "flat" learning slopes extracted from an independent word-pair learning task. Critically, poor learners showed no benefit, but also no decrement to learning, using the Generate-and-correct method. No group was harmed by errorful learning; all, except the poorest learners, benefitted from errorful learning. This study indicates, that in some rehabilitation settings, encouraging clients to guess the meaning of unfamiliar material (e.g., from cards, magazines, newspapers) and then correct their errors, could have benefits for recognition memory. Determining when and how errorful learning benefits learning is a key aim for future research.
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Affiliation(s)
- Josie Briscoe
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Joanna Doherty
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Katy Burgess
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychology, Cardiff University, Cardiff, UK
| | - Christopher Kent
- School of Psychological Science, University of Bristol, Bristol, UK
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Banderwal R, Kadian M, Garg S, Kumar A. 'Comprehensive review of emerging drug targets in traumatic brain injury (TBI): challenges and future scope. Inflammopharmacology 2024:10.1007/s10787-024-01524-w. [PMID: 39023681 DOI: 10.1007/s10787-024-01524-w] [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: 08/03/2023] [Accepted: 02/12/2024] [Indexed: 07/20/2024]
Abstract
Traumatic brain injury (TBI) is a complex brain problem that causes significant morbidity and mortality among people of all age groups. The complex pathophysiology, varied symptoms, and inadequate treatment further precipitate the problem. Further, TBI produces several psychiatric problems and other related complications in post-TBI survival patients, which are often treated symptomatically or inadequately. Several approaches, including neuroprotective agents targeting several pathways of oxidative stress, neuroinflammation, cytokines, immune system GABA, glutamatergic, microglia, and astrocytes, are being tried by researchers to develop effective treatments or magic bullets to manage the condition effectively. The problem of TBI is therefore treated as a challenge among pharmaceutical scientists or researchers to develop drugs for the effective management of this problem. The goal of the present comprehensive review is to provide an overview of the several pharmacological targets, processes, and cellular pathways that researchers are focusing on, along with an update on their current state.
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Affiliation(s)
- Rittu Banderwal
- Pharmacology Division, University Institute of Pharmaceutical Sciences (UIPS), UGC- Centre of Advanced Study (UGC-CAS), Panjab University, Chandigarh, 160014, India
| | - Monika Kadian
- Pharmacology Division, University Institute of Pharmaceutical Sciences (UIPS), UGC- Centre of Advanced Study (UGC-CAS), Panjab University, Chandigarh, 160014, India
| | - Sukant Garg
- Department of General Pathology, Dr HS Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh, 160014, India
| | - Anil Kumar
- Pharmacology Division, University Institute of Pharmaceutical Sciences (UIPS), UGC- Centre of Advanced Study (UGC-CAS), Panjab University, Chandigarh, 160014, India.
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7
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Bielanin JP, Metwally SAH, Oft HCM, Paruchuri SS, Lin L, Capuk O, Pennock ND, Song S, Sun D. NHE1 Protein in Repetitive Mild TBI-Mediated Neuroinflammation and Neurological Function Impairment. Antioxidants (Basel) 2024; 13:836. [PMID: 39061904 PMCID: PMC11274226 DOI: 10.3390/antiox13070836] [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: 04/19/2024] [Revised: 06/30/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Mild traumatic brain injuries (mTBIs) are highly prevalent and can lead to chronic behavioral and cognitive deficits often associated with the development of neurodegenerative diseases. Oxidative stress and formation of reactive oxygen species (ROS) have been implicated in mTBI-mediated axonal injury and pathogenesis. However, the underlying mechanisms and contributing factors are not completely understood. In this study, we explore these pathogenic mechanisms utilizing a murine model of repetitive mTBI (r-mTBI) involving five closed-skull concussions in young adult C57BL/6J mice. We observed a significant elevation of Na+/H+ exchanger protein (NHE1) expression in GFAP+ reactive astrocytes, IBA1+ microglia, and OLIG2+ oligodendrocytes across various brain regions (including the cerebral cortex, corpus callosum, and hippocampus) after r-mTBI. This elevation was accompanied by astrogliosis, microgliosis, and the accumulation of amyloid precursor protein (APP). Mice subjected to r-mTBI displayed impaired motor learning and spatial memory. However, post-r-mTBI administration of a potent NHE1 inhibitor, HOE642, attenuated locomotor and cognitive functional deficits as well as pathological signatures of gliosis, oxidative stress, axonal damage, and white matter damage. These findings indicate NHE1 upregulation plays a role in r-mTBI-induced oxidative stress, axonal damage, and gliosis, suggesting NHE1 may be a promising therapeutic target to alleviate mTBI-induced injuries and restore neurological function.
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Affiliation(s)
- John P. Bielanin
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Shamseldin A. H. Metwally
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Helena C. M. Oft
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Satya S. Paruchuri
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lin Lin
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Okan Capuk
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Nicholas D. Pennock
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Shanshan Song
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA 15213, USA
| | - Dandan Sun
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA 15213, USA; (J.P.B.); (S.A.H.M.); (H.C.M.O.); (S.S.P.); (L.L.); (O.C.); (N.D.P.); (S.S.)
- Pittsburgh Institute for Neurodegenerative Disorders, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Veterans Affairs Pittsburgh Health Care System, Pittsburgh, PA 15213, USA
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8
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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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9
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Wolff B, Glasson EJ, Babikian T, Pestell CF. Self-Reported Traumatic Brain Injury and Its Biopsychosocial Risk Factors in Siblings of Individuals with Neurodevelopmental Conditions. Dev Neuropsychol 2024:1-18. [PMID: 38994713 DOI: 10.1080/87565641.2024.2377689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
Siblings of individuals with neurodevelopmental conditions (NDCs) are situated within a complex system of risk and resilience factors for poor outcomes, many of which overlap with the risk of traumatic brain injury (TBI) and correlate with poorer recovery trajectories. This study used Bayesian analyses to characterize and compare TBI and biopsychosocial risk factors among 632 siblings (207 NDC, 425 controls; mean age 20.54 years, range 10-30, 78.48% female). NDC siblings had a higher self-reported lifetime history of TBI compared to controls (14.98% versus 6.35%), with most reporting more than one TBI, and at an earlier age. TBI history was associated with psychiatric diagnoses and subclinical NDC features. Family and structural factors related to TBI included poorer parent-child relationship, NDC diagnoses of autism or fetal alcohol spectrum disorder, minority ethnicity, and lower income. Findings have implications for health literacy, TBI education and screening, and implementation of family support.
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Affiliation(s)
- Brittany Wolff
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, and Jane & Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- Discipline of Psychiatry, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences and UCLA Steve Tisch BrainSPORT Program, Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, California, US
| | - Carmela F Pestell
- School of Psychological Science, The University of Western Australia, Perth, Western Australia, Australia
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10
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Cairncross M, Ledoux AA, Greenberg J, Silverberg ND. A Cross-Sectional Investigation of Trait Mindfulness, Concussion Symptom Severity, and Quality of Life in Adults with Persisting Symptoms Postconcussion. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:703-707. [PMID: 38563801 PMCID: PMC11304746 DOI: 10.1089/jicm.2023.0516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Individual differences in mindfulness may impact quality of life after concussion. In a cross-sectional analysis, the moderating effect of mindfulness was tested on the association between symptom severity and quality of life in adults with persisting postconcussion symptoms (N = 85). Mindfulness and symptom severity were independently associated with quality of life; however, mindfulness did not moderate this association. "Nonreactivity" was independently associated with quality of life; however, it was not a significant moderator. Taking a nonreactive stance, or allowing experiences to come and go without effort to change them, may be relevant to quality-of-life outcomes after concussion.
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Affiliation(s)
- Molly Cairncross
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Andrée-Anne Ledoux
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research (CHOIR), Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Noah D. Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
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11
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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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12
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Plaut ISY, Martin OY, Kahn I, Mahmood LA. Altered Mental Status in a 19-year-old Male with Hemophilia B. Pediatr Rev 2024; 45:346-349. [PMID: 38821896 DOI: 10.1542/pir.2021-005277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 06/02/2024]
Affiliation(s)
| | | | - Ilana Kahn
- Children's National Hospital, Washington, DC
- George Washington University, Washington, DC
| | - Laila A Mahmood
- Children's National Hospital, Washington, DC
- George Washington University, Washington, DC
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13
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Levy AM, Saling MM, Anderson JFI. Psychological distress and gender predict cognitive complaint after adult civilian mild traumatic brain injury in pre-morbidly healthy adults. Neuropsychol Rehabil 2024; 34:721-741. [PMID: 37493086 DOI: 10.1080/09602011.2023.2236348] [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: 12/23/2022] [Accepted: 06/24/2023] [Indexed: 07/27/2023]
Abstract
Subjective cognitive symptoms are common after mild traumatic brain injury (mTBI), and are associated with important outcome factors including return to work. This study examined self-reported cognitive symptoms in mTBI and trauma controls (TCs), and explored psychological distress and gender as predictors of these symptoms. Pre-morbidly healthy adults with mTBI (n = 68) and general trauma (n = 40) were prospectively recruited from inpatient hospital wards and assessed 6-10 weeks post-injury. Primary measures included self-reported cognitive symptoms, post-concussion symptoms, and psychological distress. Groups were matched on all background variables, including objective cognitive performance. Within this context, subjective cognitive symptoms were significantly elevated after mTBI relative to TCs (t = 3.396, p = .001). In contrast, there was no difference in post-concussion symptoms between groups (t = 1.275, p = .206). Psychological distress (β = .536, p < .001) and gender (β = .253, p = .012) predicted subjective cognitive symptoms in mTBI, with females and those with higher distress reporting greater symptoms. Unlike general post-concussion symptoms, subjective cognitive symptoms were elevated after mTBI relative to TCs, suggesting that mTBI-specific factors underly this elevation. Females and individuals with high psychological distress are important subgroups to consider for potential intervention following mTBI.
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Affiliation(s)
- Arielle M Levy
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Michael M Saling
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Jacqueline F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
- Psychology Department, The Alfred Hospital, Melbourne, Australia
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14
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Biard A, Vaittinada Ayar P, Diallo A, Gatineau-Sailliant M, Lefevre C, Cogne M, Azouvi P, Faillot T, Decq P, Faillot M. Co-existence of depression and post-concussion syndrome one month after mild traumatic brain injury. Brain Inj 2024; 38:443-447. [PMID: 38385558 DOI: 10.1080/02699052.2024.2311338] [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: 01/08/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Previous studies suggest an association between Post-concussion syndrome (PCS) and depression, both highly prevalent after mTBI. OBJECTIVE To assess the prevalence and risk-factors of depression among patients with PCS 1 month after mTBI. METHODS We prospectively screened 372 mTBI patients admitted in two academic Emergency Departments between 2017 and 2019. One month after mTBI, we administered the Rivermead Post-concussion symptoms Questionnaire (RPQ) and the Patient Health Questionnaire (PHQ-9) questionnaires over the telephone. PCS and depression were defined by RPQ ≥ 12 and PHQ-9 ≥ 10. Multivariate multinomial regression identified baseline factors associated with PCS and depression. RESULTS Two hundred and eight completed RPQ and PHQ-9. Forty-seven patients (22.5%) met criteria for PCS, among which 22 (46.8%) met criteria for depression (PCS+D+). Patients with PCS but without depression were less likely to present with an associated injury (Coefficient = -1.6, p = 0.047) and to report initial sadness (Coefficient = -2.5, p = 0.03). Initial sadness (Coefficient = -1.3, p = 0.047), associated injury (Coefficient = -1.9, p = 0.008), as well as initial nausea (Coefficient = -1.8, p = 0.002), and male sex (Coefficient = 1.8, p = 0.002), were associated with the absence of depression and PCS in comparison with PCS+D+ patients. CONCLUSION Among patients with PCS 1 month after mTBI, those with depression are more likely to present with initial sadness and with an associated injury.
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Affiliation(s)
- Adam Biard
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
| | - Prabakar Vaittinada Ayar
- Emergency Department, Beaujon University Hospital, Greater Paris Hospitals APHP, Clichy, France
- UMR-S 942, INSERM, MASCOT
| | - Alhassane Diallo
- Epidemiology Department, Biostatistics and Clinical Research, Greater Paris Hospitals (APHP), Bichat University Hospital, Paris, France
| | - Maryame Gatineau-Sailliant
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
| | - Clémence Lefevre
- Physical Medicine and Rehabilitation Department, Greater Paris Hospital (APHP), Raymond Poincare, Garches, France
| | - Mélanie Cogne
- Physical Medicine and Rehabilitation Department, Greater Paris Hospital (APHP), Raymond Poincare, Garches, France
| | - Philippe Azouvi
- Physical Medicine and Rehabilitation Department, Greater Paris Hospital (APHP), Raymond Poincare, Garches, France
| | - Thierry Faillot
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
| | - Philippe Decq
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
| | - Matthieu Faillot
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
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15
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Piwowarczyk S, Obłój P, Janicki Ł, Kowalik K, Łukaszuk A, Siemiński M. Seizure-Related Head Injuries: A Narrative Review. Brain Sci 2024; 14:473. [PMID: 38790452 PMCID: PMC11118010 DOI: 10.3390/brainsci14050473] [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: 04/10/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Epilepsy is one of the most common neurological diseases. Epileptic seizures very often result in head injuries that may lead to many adverse consequences, both acute and chronic. They contribute to the need for hospitalization, modification of treatment, and a general decline in social productivity. The objective of our review is to characterize and assess management aspects of seizure-related head injuries (SRHIs) as an important and frequent clinical problem present in emergency department settings. PubMed and other relevant databases and websites were systematically searched for articles on traumatic brain injuries connected with the occurrence of seizures published from inception to 9 April 2024; then, we reviewed the available literature. Our review showed that SRHIs can lead to various acute complications, in some cases requiring hospitalization and neurosurgical intervention. Long-term complications and cognitive decline after injury might be present, eventually implying a negative impact on a patient's quality of life. Despite being frequent and clinically important, there are still no widely accepted, uniform recommendations for the management of patients with SRHIs. As such, a concise and standardized protocol for the management of seizure-related head injuries in emergency departments is worth consideration.
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Affiliation(s)
- Sebastian Piwowarczyk
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
| | - Paweł Obłój
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
| | - Łukasz Janicki
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
| | - Kornelia Kowalik
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
| | - Adam Łukaszuk
- Edinburgh Medical School, College of Medicine And Veterinary Medicine, The University of Edinburgh, Edinburgh EH8 9YL, UK;
| | - Mariusz Siemiński
- Department of Emergency Medicine, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-952 Gdansk, Poland; (S.P.); (P.O.); (Ł.J.); (K.K.)
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16
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Ren S, McDonald CC, Corwin DJ, Wiebe DJ, Master CL, Arbogast KB. Response Rate Patterns in Adolescents With Concussion Using Mobile Health and Remote Patient Monitoring: Observational Study. JMIR Pediatr Parent 2024; 7:e53186. [PMID: 38722194 PMCID: PMC11089889 DOI: 10.2196/53186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/05/2024] [Accepted: 03/26/2024] [Indexed: 05/15/2024] Open
Abstract
Background A concussion is a common adolescent injury that can result in a constellation of symptoms, negatively affecting academic performance, neurobiological development, and quality of life. Mobile health (mHealth) technologies, such as apps for patients to report symptoms or wearables to measure physiological metrics like heart rate, have been shown to be promising in health maintenance. However, there is limited evidence about mHealth engagement in adolescents with a concussion during their recovery course. Objective This study aims to determine the response rate and response rate patterns in concussed adolescents reporting their daily symptoms through mHealth technology. It will also examine the effect of time-, demographic-, and injury-related characteristics on response rate patterns. Methods Participants aged between 11-18 years (median days since injury at enrollment: 11 days) were recruited from the concussion program of a tertiary care academic medical center and a suburban school's athletic teams. They were asked to report their daily symptoms using a mobile app. Participants were prompted to complete the Post-Concussion Symptom Inventory (PCSI) 3 times (ie, morning, afternoon, and evening) per day for 4 weeks following enrollment. The primary outcome was the response rate pattern over time (by day since initial app use and the day since injury). Time-, demographic-, and injury-related differences in reporting behaviors were compared using Mann Whitney U tests. Results A total of 56 participants were enrolled (mean age 15.3, SD 1.9 years; n=32, 57% female). The median response rate across all days of app use in the evening was 37.0% (IQR 27.2%-46.4%), which was significantly higher than the morning (21.2%, IQR 15.6%-30.5%) or afternoon (26.4%, IQR 21.1%-31.5%; P<.001). The median daily response was significantly different by sex (female: 53.8%, IQR 46.2%-64.2% vs male: 42.0%, IQR 28.6%-51.1%; P=.003), days since injury to app use (participants starting to use the app >7 days since injury: 54.1%, IQR 47.4%-62.2% vs starting to use the app ≤7 days since injury: 38.0%, IQR 26.0%-53.3%; P=.002), and concussion history (participants with a history of at least one prior concussion: 57.4%, IQR 44.5%-70.5% vs participants without concussion history: 42.3%, IQR 36.8%-53.5%; P=.03). There were no significant differences by age. Differences by injury mechanism (sports- and recreation-related injury: 39.6%, IQR 36.1%-50.4% vs non-sports- or recreation-related injury: 30.6%, IQR 20.0%-42.9%; P=.04) and initial symptom burden (PCSI scores greater than the median score of 47: 40.9%, IQR 35.2%-53.8% vs PCSI scores less than or equal to the median score: 31.9%, IQR 24.6%-40.6%; P=.04) were evident in the evening response rates; however, daily rates were not statistically different. Conclusions Evening may be the optimal time to prompt for daily concussion symptom assessment among concussed adolescents compared with morning or afternoon. Multiple demographic- and injury-related characteristics were associated with higher daily response rates, including for female participants, those with more than 1 week from injury to beginning mHealth monitoring, and those with a history of at least one previous concussion. Future studies may consider incentive strategies or adaptive digital concussion assessments to increase response rates in populations with low engagement.
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Affiliation(s)
- Sicong Ren
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Catherine C McDonald
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel J Corwin
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Douglas J Wiebe
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, PA, United States
| | - Christina L Master
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Sports Medicine and Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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17
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Karvandi E, Barrett L, Newcombe V, Hutchinson P, Helmy A. Digital health interventions for remote follow-up after mild traumatic brain injury. Br J Neurosurg 2024:1-7. [PMID: 38711206 DOI: 10.1080/02688697.2024.2346564] [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: 09/20/2023] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND After a mild traumatic brain injury (mild TBI,) a significant number of patients may experience persistent symptoms and disabilities for months to years. Early identification and timely management of persistent symptoms may help to reduce the long-term impacts of mild TBIs. There is currently no formalised method for identifying patients with persistent symptoms after mild TBI once they are discharged from emergency department. OBJECTIVE Assess the feasibility of a remote monitoring tool for early identification of persistent symptoms after mild TBI in the outpatient setting using digital tools. METHODS Electronic surveys were sent to patients with mild TBI who presented to the emergency department at a Major Trauma Centre in England. The surveys were completed at three different timepoints (within days of injury (S1), 1 month (S2), and 3 months (S3) after injury). The indicators used to assess feasibility were engagement, number of eligible patients for follow-up evidence of need for the intervention, and consistency with the literature. Feedback was sought from participants. RESULTS Of the 200 people invited to participate, 134 (67.0%) completed S1, 115 (57.5%) completed S2, and 95 (47.5%) completed S3. The rates of persistent symptoms ranged from 17.9%-62.6% depending on the criteria used, and we found a significant proportion of the participants experienced morbidity 1 and 3 months after injury. The electronic follow-up tool was deemed an acceptable and user-friendly method for service delivery by participants. CONCLUSION Using digital tools to monitor and screen mild TBI patients for persistent symptoms is feasible. This could be a scalable, cost-effective, and convenient solution which could improve access to healthcare and reduce healthcare inequalities. This could enable early identification of patients with further medical needs and facilitate timely intervention to improve the clinical workflows, patient satisfaction, and health outcomes for people with persistent morbidities after mild TBIs.
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Affiliation(s)
- Elika Karvandi
- Division of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Liam Barrett
- PACE, Department of Medicine, University of Cambridge, Cambridge, UK
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Virginia Newcombe
- PACE, Department of Medicine, University of Cambridge, Cambridge, UK
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter Hutchinson
- Division of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Adel Helmy
- Division of Neurosurgery, University of Cambridge, Cambridge, UK
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18
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Chan ST, Mercaldo N, Figueiro Longo MG, Welt J, Avesta A, Lee J, Lev MH, Ratai EM, Wenke MR, Parry BA, Drake L, Anderson RR, Rauch T, Diaz-Arrastia R, Kwong KK, Hamblin M, Vakoc BJ, Gupta R, Panzer A. Effects of Low-Level Light Therapy on Resting-State Connectivity Following Moderate Traumatic Brain Injury: Secondary Analyses of a Double-blinded Placebo-controlled Study. Radiology 2024; 311:e230999. [PMID: 38805733 PMCID: PMC11140530 DOI: 10.1148/radiol.230999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 02/28/2024] [Accepted: 04/08/2024] [Indexed: 05/30/2024]
Abstract
Background Low-level light therapy (LLLT) has been shown to modulate recovery in patients with traumatic brain injury (TBI). However, the impact of LLLT on the functional connectivity of the brain when at rest has not been well studied. Purpose To use functional MRI to assess the effect of LLLT on whole-brain resting-state functional connectivity (RSFC) in patients with moderate TBI at acute (within 1 week), subacute (2-3 weeks), and late-subacute (3 months) recovery phases. Materials and Methods This is a secondary analysis of a prospective single-site double-blinded sham-controlled study conducted in patients presenting to the emergency department with moderate TBI from November 2015 to July 2019. Participants were randomized for LLLT and sham treatment. The primary outcome of the study was to assess structural connectivity, and RSFC was collected as the secondary outcome. MRI was used to measure RSFC in 82 brain regions in participants during the three recovery phases. Healthy individuals who did not receive treatment were imaged at a single time point to provide control values. The Pearson correlation coefficient was estimated to assess the connectivity strength for each brain region pair, and estimates of the differences in Fisher z-transformed correlation coefficients (hereafter, z differences) were compared between recovery phases and treatment groups using a linear mixed-effects regression model. These analyses were repeated for all brain region pairs. False discovery rate (FDR)-adjusted P values were computed to account for multiple comparisons. Quantile mixed-effects models were constructed to quantify the association between the Rivermead Postconcussion Symptoms Questionnaire (RPQ) score, recovery phase, and treatment group. Results RSFC was evaluated in 17 LLLT-treated participants (median age, 50 years [IQR, 25-67 years]; nine female), 21 sham-treated participants (median age, 50 years [IQR, 43-59 years]; 11 female), and 23 healthy control participants (median age, 42 years [IQR, 32-54 years]; 13 male). Seven brain region pairs exhibited a greater change in connectivity in LLLT-treated participants than in sham-treated participants between the acute and subacute phases (range of z differences, 0.37 [95% CI: 0.20, 0.53] to 0.45 [95% CI: 0.24, 0.67]; FDR-adjusted P value range, .010-.047). Thirteen different brain region pairs showed an increase in connectivity in sham-treated participants between the subacute and late-subacute phases (range of z differences, 0.17 [95% CI: 0.09, 0.25] to 0.26 [95% CI: 0.14, 0.39]; FDR-adjusted P value range, .020-.047). There was no evidence of a difference in clinical outcomes between LLLT-treated and sham-treated participants (range of differences in medians, -3.54 [95% CI: -12.65, 5.57] to -0.59 [95% CI: -7.31, 8.49]; P value range, .44-.99), as measured according to RPQ scores. Conclusion Despite the small sample size, the change in RSFC from the acute to subacute phases of recovery was greater in LLLT-treated than sham-treated participants, suggesting that acute-phase LLLT may have an impact on resting-state neuronal circuits in the early recovery phase of moderate TBI. ClinicalTrials.gov Identifier: NCT02233413 © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
| | | | - Maria G. Figueiro Longo
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Jonathan Welt
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Arman Avesta
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Jarone Lee
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Michael H. Lev
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Eva-Maria Ratai
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Michael R. Wenke
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Blair A. Parry
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Lynn Drake
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Richard R. Anderson
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Terry Rauch
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Ramon Diaz-Arrastia
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Kenneth K. Kwong
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | - Michael Hamblin
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
| | | | | | - Ariane Panzer
- From the Athinoula A. Martinos Center for Biomedical Imaging (S.T.C.,
E.M.R., K.K.K.), Department of Radiology (S.T.C., N.M., M.G.F.L., A.A., M.H.L.,
E.M.R., K.K.K., R.G.), Wellman Center for Photomedicine (L.D., R.R.A., M.H.,
B.J.V.), Department of Emergency Medicine (J.L., B.A.P.), and Department of
Surgery (J.L.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02129;
Department of Anesthesiology and Perioperative Care, University of California
Irvine, Orange, Calif (J.W.); Department of Radiology, Yale School of Medicine,
New Haven, Conn (A.A.); Neuroscience Institute, Huck Institutes of the Life
Sciences, Pennsylvania State University, State College, Pa (M.R.W.);
Pennsylvania State College of Medicine, Milton S. Hershey Medical Center,
Hershey, Pa (M.R.W.); Office of Secretary of Defense, Department of Defense,
Washington, DC (T.R.); and Department of Neurology, University of Pennsylvania,
Philadelphia, Pa (R.D.A.)
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19
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Ingram BM, DeFreese JD, Kerr ZY, Oyesanya TO, Picha KJ, Register-Mihalik JK. Applying the National Institute on Minority Health and Health Disparities Research Framework to Social Determinants of Health in the Context of Sport-Related Concussion: A Clinical Commentary. J Athl Train 2024; 59:447-457. [PMID: 38446622 PMCID: PMC11127672 DOI: 10.4085/1062-6050-0370.23] [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: 03/08/2024]
Abstract
Sport-related concussion (SRC) is a prevalent injury. Significant disparities in SRC outcomes exist across racial and ethnic groups. These disparities may be attributed to the unequal distribution of political power (or influence) and resource allocation in various communities, shaping individuals' social determinants of health (SDOH). However, the influence of SDOH on SRC outcomes remains understudied. In this clinical commentary, we use the National Institute on Minority Health and Health Disparities Research Framework and describe how its application can help address gaps in our understanding of SDOH and SRC. This framework provides a comprehensive approach to investigating and addressing health disparities by considering SDOH along multiple levels and domains of influence. Using this framework, athletic trainers can identify areas requiring intervention and better understand how SDOH influence SRC outcomes. This understanding can help athletic trainers develop tailored interventions to promote equitable care for patients with SRC.
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Affiliation(s)
- Brittany M. Ingram
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | | | - Kelsey J. Picha
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ
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20
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Evans RW. The Postconcussion Syndrome and Posttraumatic Headaches in Civilians, Soldiers, and Athletes. Neurol Clin 2024; 42:341-373. [PMID: 38575256 DOI: 10.1016/j.ncl.2023.12.001] [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: 04/06/2024]
Abstract
Posttraumatic headaches are one of the most common and controversial secondary headache types. After a mild traumatic brain, an estimated 11% to 82% of people develop a postconcussion syndrome, which has been controversial for more than 160 years. Headache is estimated as present in 30% to 90% of patients after a mild head injury. Most headaches are tension-type-like or migraine-like. Headaches in civilians, soldiers, athletes, and postcraniotomy are reviewed. The treatments are the same as for the primary headaches. Persistent posttraumatic headaches can continue for many years.
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Affiliation(s)
- Randolph W Evans
- Neurology, Baylor College of Medicine, 1200 Binz #1370, Houston, TX 77004, USA.
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21
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O'Kane KMK, Otamendi T, Silverberg ND, Choi E, Sicard V, Zemek R, Healey K, Brown O, Butterfield L, Smith A, Goldfield G, Kardish R, Saab BJ, Ledoux AA, Cairncross M. Development of Therapeutic Alliance and Social Presence in a Digital Intervention for Pediatric Concussion: Qualitative Exploratory Study. JMIR Form Res 2024; 8:e49133. [PMID: 38517472 PMCID: PMC10998177 DOI: 10.2196/49133] [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: 06/27/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Despite the promising benefits of self-guided digital interventions for adolescents recovering from concussion, attrition rates for such interventions are high. Evidence suggests that adults can develop therapeutic alliance with self-guided digital interventions, which is in turn associated with intervention engagement. However, no research has examined whether adolescents develop therapeutic alliance with self-guided digital interventions and what factors are important to its development. Additionally, social presence-the extent to which digital encounters feel like they are occurring in person-may be another relevant factor to understanding the nature of the connection between adolescents and a self-guided digital intervention, though this has yet to be explored. OBJECTIVE This qualitative study explored the extent to which adolescents recovering from concussion developed therapeutic alliance and social presence during their use of a self-guided digital mindfulness-based intervention. Additionally, this study aimed to determine factors important to adolescents' development of therapeutic alliance and social presence with the intervention. METHODS Adolescents aged between 12 and 17.99 years who sustained a concussion were recruited from 2 sites: a pediatric emergency department up to 48 hours after a concussion and a tertiary care clinic over 1 month following a concussion to capture adolescents who had both acute and persisting symptoms after concussion. Participants (N=10) completed a 4-week mindfulness-based intervention delivered through a smartphone app. Within the app, participants listened to audio recordings of mindfulness guides (voice actors) narrating psychoeducation and mindfulness practices. At 4 weeks, participants completed questionnaires and a semistructured interview exploring their experience of therapeutic alliance and social presence with the mindfulness guides in the intervention. RESULTS Themes identified within the qualitative results revealed that participants developed therapeutic alliance and social presence by "developing a genuine connection" with their mindfulness guides and "sensing real people." Particularly important to the development of therapeutic alliance and social presence were the mindfulness guides' "personal backgrounds and voices," such that participants felt more connected to the guides by knowing information about them and through the guides' calm tone of voice in audio recordings. Quantitative findings supported qualitative results; participants' average score for therapeutic alliance was far above the scale midpoint, while the mixed results for social presence measures aligned with qualitative findings that participants felt that the mindfulness guides seemed real but not quite as real as an in-person connection would. CONCLUSIONS Our data suggest that adolescents can develop therapeutic alliance and social presence when using digital interventions with no direct human contact. Adolescents' development of therapeutic alliance and social presence with self-guided digital interventions can be bolstered by increasing human-like qualities (eg, real voices) within interventions. Maximizing therapeutic alliance and social presence may be a promising way to reduce attrition in self-guided digital interventions while providing accessible treatment.
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Affiliation(s)
- Kiarah M K O'Kane
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Thalia Otamendi
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Esther Choi
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Veronik Sicard
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Katherine Healey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Olivier Brown
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lauren Butterfield
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Andra Smith
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Gary Goldfield
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Rachel Kardish
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Andrée-Anne Ledoux
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Molly Cairncross
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
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22
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Faulkner JW, Whiting D, Theadom A, Snell DL, Roche M, Barker-Collo S. Valued living after mild traumatic brain injury: Characteristics and relationship with outcomes. Neuropsychol Rehabil 2024:1-17. [PMID: 38497571 DOI: 10.1080/09602011.2024.2328876] [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: 09/06/2023] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
Psychological factors are strong predictors of mild traumatic brain injury (mTBI) recovery, consequently, psychological interventions can form part of an individual's rehabilitation. This may include enhancing valued living (VL), an approach that is effective in severe and mixed acquired brain injury samples. This study aimed to characterize VL in mTBI and explore its relationship with mTBI and mental health outcomes. 56 participants with a mTBI completed self-report measures before engaging in a psychological intervention. Pre-injury mental health and other demographic and injury-related variables, VL, post-concussion symptoms (PCS), functional disability, and stress, anxiety and depression were measured. A pre-injury mental health condition was significantly associated with VL. VL was uniquely associated with depression after mTBI (β = -0.08, p = .05), however, there was no relationship with PCS, functional disability, stress or anxiety (p > .05). Following mTBI individuals with a pre-injury mental health condition or who experience heightened depressive symptoms may benefit from a values-based intervention as part of their rehabilitation. Future research, however, is needed to examine the role of VL in mTBI recovery.
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Affiliation(s)
- Josh W Faulkner
- Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
| | - Diane Whiting
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Australia
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Alice Theadom
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Maree Roche
- School of Management, Fellow NZ Psychological Society, Auckland University, Auckland, New Zealand
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23
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Joseph CR, Lim JK, Grohol BN, Zivcevska M, Lencke J, Rich ED, Arrasmith CJ, Dorman IS, Clark BW, Love K, Ferry B, Rolfs ME. Identifying delay in glymphatic clearance of labeled protons post-acute head trauma utilizing 3D ASL MRI (arterial spin labeling): a pilot study. Sci Rep 2024; 14:6188. [PMID: 38485759 PMCID: PMC10940642 DOI: 10.1038/s41598-024-56236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
This study correlated mild traumatic brain injury (mTBI) cognitive changes with ASL-MRI glymphatic clearance rates (GCRs) and recovery with GCR improvement. mTBI disrupts the blood brain barrier (BBB), reducing capillary mean transit time and GCRs. mTBI is clinically diagnosed utilizing history/examination findings with no physiologic biomarkers. 3D TGSE (turbo-gradient spin-echo) pulsed arterial spin-labeling 3T MRI with 7 long inversion times (TIs) assessed the signal clearance of labeled protons 2800-4000 ms postlabeling in bifrontal, bitemporal, and biparietal regions within 7 days of mTBI and once clinically cleared to resume activities. The Sport Concussion Assessment Tool Version 5 (SKAT5) and Brief Oculomotor/Vestibular Assessment evaluated injured athletes' cognitive function prior to MRIs. The pilot study demonstrated significant GCRs improvement (95% CI - 0.06 to - 0.03 acute phase; to CI-recovery CI 0.0772 to - 0.0497; P < 0.001 in frontal lobes; and parietal lobes (95% CI - 0.0584 to - 0.0251 acute; CI - 0.0727 to - 0.0392 recovery; P = 0.024) in 9 mTBI athletes (8 female, 1 male). Six age/activity-matched controls (4 females, 2 males) were also compared. mTBI disrupts the BBB, reducing GCR measured using the 3D ASL MRI technique. ASL MRI is a potential noninvasive biomarker of mTBI and subsequent recovery.
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Affiliation(s)
- Charles R Joseph
- Liberty University College of Osteopathic Medicine, Lynchburg, USA.
| | - Jubin Kang Lim
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Bryce N Grohol
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Marija Zivcevska
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Joshua Lencke
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Ethan Dean Rich
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | | | | | | | - Kim Love
- K. R. Love Quantitative Consulting and Collaboration, Athens, USA
| | - Ben Ferry
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Mark E Rolfs
- Liberty University College of Osteopathic Medicine, Lynchburg, USA
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24
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Pei Y, O'Brien KH. Use of Social Media Data Mining to Examine Needs, Concerns, and Experiences of People With Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:831-847. [PMID: 38147471 DOI: 10.1044/2023_ajslp-23-00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
PURPOSE Given the limited availability of topic-specific resources, many people turn to anonymous social media platforms such as Reddit to seek information and connect to others with similar experiences and needs. Mining of such data can therefore identify unmet needs within the community and allow speech-language pathologists to incorporate clients' real-life insights into clinical practices. METHOD A mixed-method analysis was performed on 3,648 traumatic brain injury (TBI) subreddit posts created between 2013 and 2021. Sentiment analysis was used to determine the sentiment expressed in each post; topic modeling and qualitative content analysis were used to uncover the main topics discussed across posts. Subgroup analyses were conducted based on injury severity, chronicity, and whether the post was authored by a person with TBI or a close other. RESULTS There was no significant difference between the number of posts with positive sentiment and the number of posts with negative sentiment. Comparisons between subgroups showed significantly higher positive sentiment in posts by or about people with moderate-to-severe TBI (compared to mild TBI) and who were more than 1 month postinjury (compared to less than 1 month). Posts by close others had significantly higher positive sentiment than posts by people with TBI. Topic modeling identified three meta-themes: Recovery, Symptoms, and Medical Care. Qualitative content analysis further revealed that returning to productivity and life as well as sharing recovery tips were the primary focus under the Recovery theme. Symptom-related posts often discussed symptom management and validation of experiences. The Medical Care theme encompassed concerns regarding diagnosis, medication, and treatment. CONCLUSIONS Concerns and needs shift over time following TBI, and they extend beyond health and functioning to participation in meaningful daily activities. The findings can inform the development of tailored educational resources and rehabilitative approaches, facilitating recovery and community building for individuals with TBI. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24881340.
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Affiliation(s)
- Yalian Pei
- Department of Communication Sciences and Special Education, University of Georgia, Athens
- Department of Communication Sciences and Disorders, Syracuse University, NY
| | - Katy H O'Brien
- Department of Communication Sciences and Special Education, University of Georgia, Athens
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN
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25
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Dupont D, Tang K, Beaudoin C, Dégeilh F, Gagnon I, Yeates KO, Rose SC, Gravel J, Burstein B, Stang AS, Stanley RM, Zemek RL, Beauchamp MH. Postconcussive Symptoms After Early Childhood Concussion. JAMA Netw Open 2024; 7:e243182. [PMID: 38512252 PMCID: PMC10958232 DOI: 10.1001/jamanetworkopen.2024.3182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
Importance Research on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their evolution in young children. Objective To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure. Design, Setting, and Participants This cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids' Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024. Exposure Concussion sustained between ages 6 and 72 months. Main Outcomes and Measures Primary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations & Symptoms inventory. Group comparisons were analyzed using ordinal regression models. Results The study included 303 children (mean [SD] age, 35.8 [20.2] months; 152 [50.2%] male). Of these, 174 children had a concussion (mean [SD] age, 33.3 [19.9] months), 60 children had an OI (mean [SD] age, 38.4 [19.8] months) and 69 children were uninjured controls (mean [SD] age, 39.7 [20.8] months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio [OR], 4.33 [95% CI, 2.44-7.69]; concussion vs control: OR, 7.28 [95% CI, 3.80-13.93]), 10 days (concussion vs OI: OR, 4.44 [95% CI, 2.17-9.06]; concussion vs control: OR, 5.94 [95% CI, 3.22-10.94]), 1 month (concussion vs OI: OR, 2.70 [95% CI, 1.56-4.68]; concussion vs control: OR, 4.32 [95% CI, 2.36-7.92]), and 3 months (concussion vs OI: OR, 2.61 [95% CI, 1.30-5.25]; concussion vs control: OR, 2.40 [95% CI, 1.36-4.24]). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points. Conclusions and Relevance In this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.
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Affiliation(s)
- Dominique Dupont
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Ken Tang
- Independent Statistical Consultant, Richmond, British Columbia
| | - Cindy Beaudoin
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Fanny Dégeilh
- Univ Rennes, CNRS (Centre national de recherche scientifique), Inria, Inserm, IRISA (Institut de recherche en informatique et systèmes aléatoires) UMR (Unité mixte de recherche) 6074, EMPENN - ERL (Equipe de recherche labellisée) U1228, Rennes, France
| | - Isabelle Gagnon
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Keith Owen Yeates
- Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Sean C Rose
- Child Neurology, Nationwide Children's Hospital, Columbus, Ohio
- The Ohio State University College of Medicine Columbus, Columbus
| | - Jocelyn Gravel
- Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Brett Burstein
- Montreal Children's Hospital, Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Antonia S Stang
- Department of Pediatrics, University of Calgary, Calgary Alberta, Canada
| | - Rachel M Stanley
- The Ohio State University College of Medicine Columbus, Columbus
- Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Roger L Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ontario, Canada
| | - Miriam H Beauchamp
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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Boone AE, Henderson WL, Zenoozi S. Surveying the Landscape of Persistent Concussive Symptoms in Adults Through an Occupational Lens. Am J Occup Ther 2024; 78:7802180190. [PMID: 38373065 DOI: 10.5014/ajot.2024.050405] [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: 02/21/2024] Open
Abstract
IMPORTANCE Little is known about how and to what extent persistent concussive symptoms affect occupational performance in adults. OBJECTIVE To evaluate the impact of persistent postconcussive symptoms on occupational performance. DESIGN A cross-sectional study design was used in which the occupational performance needs of adults with persistent concussion symptoms were identified by a trained occupational therapist via semistructured interview. SETTING University research space. PARTICIPANTS Adults ages 18 to 60 yr experiencing persistent concussion symptoms. OUTCOMES AND MEASURES Occupational performance was evaluated using the Canadian Occupational Performance Measure. Data were then categorized by two researchers using the Occupational Therapy Practice Framework: Domain and Process (4th ed.). RESULTS The most commonly affected occupational performance areas included education and work, social participation, and performance of instrumental activities of daily living. CONCLUSIONS AND RELEVANCE Aligning with prior knowledge of the impact of psychosocial difficulties and higher order cognitive deficits on daily life, performance of complex occupations is heavily affected in adults with persistent concussive symptoms. Plain-Language Summary: The functional impact of symptoms that adults experience postconcussion becomes apparent as they return to their life occupations. The results of this study showed that adults with persistent concussive symptoms more commonly experienced occupational challenges with participation in education, social activities, and the performance of instrumental activities of daily living, with subtle, important variations in symptoms across adults. Detailed, client-centered evaluation of occupational performance changes postconcussion is an area of potential growth for occupational therapy practice and research.
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Affiliation(s)
- Anna E Boone
- Anna E. Boone, PhD, MSOT, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Whitney L Henderson
- Whitney L. Henderson, OTD, MOT, OTR/L, is Associate Clinical Professor, Department of Occupational Therapy, University of Missouri, Columbia
| | - Sepideh Zenoozi
- Sepideh Zenoozi, MSc, OTR, is Predoctoral Trainee, Department of Occupational Therapy, University of Missouri, Columbia
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Bigler ED. PREFACE to what traditional neuropsychological assessment got wrong about mild traumatic brain injury. A four-part opinion review. Brain Inj 2024:1-7. [PMID: 38415677 DOI: 10.1080/02699052.2024.2321931] [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: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 02/29/2024]
Abstract
This Preface overviews a four-part opinion series on the role of tradtional neuropsychological tests in evaluating mild traumatic brain injury (mTBI), juxtaposed to all of the progress that has occurred with advanced neuroimaging and allied technologies. The four areas of review and critique are: I. Neuropathology; II: Limitations in Test Development, Statistical and Psychometric Issues; III. Implications of Advanced Neuroimaging Findings inn the Neuropsychological Assessment of the mTBI Patient, and IV: Clinical Applications and Future Directions. The example is made that since their inception in the early to mid-20th Century, traditional neuropsychological measures mostly have remained invariant, have been used as omnibus measures for assessing all types of neurological and neuropsychiatric conditions, and were never specifically designed to asses the effects of mTBI. Extensive discussion is provided across all four parts concerning the limits of traditional neuropsychological methods, especially in the absences of any integration with advanced neuroimaging and biomarker findings. Part IV provides an outline for future research and clinical application in the development of novel neuropsychological assessment mesasures specific to mTBI.
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Affiliation(s)
- Erin D Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
- Departments of Neurology and Psychiatry, University of Utah, Salt Lake City, Utah, USA
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Rybkina J, Jacob N, Colella B, Gold D, Stewart DE, Ruttan LA, Meusel LAC, McAndrews MP, Abbey S, Green R. Self-managing symptoms of Long COVID: an education and strategies research protocol. Front Public Health 2024; 12:1106578. [PMID: 38384879 PMCID: PMC10879441 DOI: 10.3389/fpubh.2024.1106578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/04/2024] [Indexed: 02/23/2024] Open
Abstract
Post-acute sequelae of SARS-COV-2 (PASC) is growing in prevalence, and involves symptoms originating from the central neurological, cardiovascular, respiratory, gastrointestinal, autonomic nervous, or immune systems. There are non-specific symptoms such as fatigue, headaches, and brain fog, which cannot be ascribed to a single system. PASC places a notable strain on our healthcare system, which is already laden with a large number of acute-COVID-19 patients. Furthermore, it impedes social, academic and vocational functioning, and impacts family life, relationships, and work/financial life. The treatment for PASC needs to target this non-specific etiology and wide-ranging sequelae. In conditions similar to PASC, such as "chemo brain," and prolonged symptoms of concussion, the non-specific symptoms have shown to be effectively managed through education and strategies for self-management and Mindfulness interventions. However, such interventions have yet to be empirically evaluated in PASC to our knowledge. In response to this gap, we have developed a virtual education intervention synthesized by psychiatrists and clinical psychologists for the current study. We will undertake a two-phase randomized controlled trial to determine the feasibility (Phase 1; N = 90) and efficacy (Phase 2; sample sized based on phase 1 results) of the novel 8 week Education and Self-Management Strategies group compared to a mindfulness skills program, both delivered virtually. Main outcomes include confidence/ability to self-manage symptoms, quality of life, and healthcare utilization. This study stands to mitigate the deleterious intrusiveness of symptoms on everyday life in patients with PASC, and may also help to reduce the impact of PASC on the healthcare system. Clinical trial registration:https://classic.clinicaltrials.gov/ct2/show/NCT05268523; identifier NCT05268523.
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Affiliation(s)
- Julia Rybkina
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON, Canada
| | - Nithin Jacob
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON, Canada
| | - Brenda Colella
- Telerehab Centre for Acquired Brain Injury, Toronto Rehabilitation Institute—University Centre, University Health Network, Toronto, ON, Canada
| | - David Gold
- Krembil Brain Institute, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Donna E. Stewart
- University of Toronto, Centre for Mental Health and Senior Scientist, University Health Network, Toronto, ON, Canada
| | - Lesley A. Ruttan
- University of Toronto Scarborough, Neuro-Rehab Program, Toronto Rehabilitation Institute—University Centre, University Health Network, Toronto, ON, Canada
| | - Liesel-Ann C. Meusel
- Telerehab Centre for Acquired Brain Injury, Toronto Rehabilitation Institute—University Centre, University Health Network, Toronto, ON, Canada
| | - Mary P. McAndrews
- Krembil Research Institute, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Susan Abbey
- Medical Psychiatry and Psychiatry and Psychosocial Oncology, University Health Network, Toronto, ON, Canada
| | - Robin Green
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Division of Neurosciences and Clinical Translation, University of Toronto, Toronto, ON, Canada
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Wallace TD, Knollman-Porter K, Brown J, Schwartz A, Hodge A, Brown G, Beardslee J, Gore RK. mTBI evaluation, management, and referral to allied healthcare: practices of first-line healthcare professionals. Brain Inj 2024; 38:32-44. [PMID: 38333958 DOI: 10.1080/02699052.2024.2309245] [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: 05/27/2022] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
PRIMARY OBJECTIVE To gain an understanding of current evaluation practices, post-injury recommendations, and referrals to allied healthcare professions (AHP) by first-line healthcare professionals (FHPs) providing care for people with mild traumatic brain injury (mTBI). RESEARCH DESIGN Survey study. METHODS AND PROCEDURES Physicians, physician assistants, nurse practitioners, nurses, and athletic trainers (n = 126) completed an online survey, including Likert scale and free response question relating to mTBI evaluation, management, and referral practices. MAIN OUTCOMES AND RESULTS FHPs surveyed reported being confident in their ability to evaluate patients with suspected mTBI, relying most heavily on patient-reported symptoms and physical signs as methods of evaluation. Most FHPs reported making recommendations to compensate for the symptoms experienced following mTBI diagnosis. In contrast, FHPs expressed challenges in the evaluation and management of symptoms associated with mTBI along with limited knowledge of and referrals to AHPs. CONCLUSIONS Overall, FHPs feel confident in the diagnosis of mTBI but experience assessment and management challenges. AHPs are underutilized on mTBI management teams calling for a need for multidisciplinary collaboration on research, education, and rehabilitation efforts to optimally care for people experiencing mTBI symptoms.
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Affiliation(s)
- Tracey D Wallace
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
- SHARE Military Initiative, Shepherd Center, Atlanta, Georgia, USA
| | | | | | - Amber Schwartz
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
- SHARE Military Initiative, Shepherd Center, Atlanta, Georgia, USA
| | - April Hodge
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
| | - Gregory Brown
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
- SHARE Military Initiative, Shepherd Center, Atlanta, Georgia, USA
| | | | - Russell K Gore
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia, USA
- SHARE Military Initiative, Shepherd Center, Atlanta, Georgia, USA
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van der Horn HJ, Ling JM, Wick TV, Dodd AB, Robertson-Benta CR, McQuaid JR, Zotev V, Vakhtin AA, Ryman SG, Cabral J, Phillips JP, Campbell RA, Sapien RE, Mayer AR. Dynamic Functional Connectivity in Pediatric Mild Traumatic Brain Injury. Neuroimage 2024; 285:120470. [PMID: 38016527 PMCID: PMC10815936 DOI: 10.1016/j.neuroimage.2023.120470] [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: 09/13/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
Resting-state fMRI can be used to identify recurrent oscillatory patterns of functional connectivity within the human brain, also known as dynamic brain states. Alterations in dynamic brain states are highly likely to occur following pediatric mild traumatic brain injury (pmTBI) due to the active developmental changes. The current study used resting-state fMRI to investigate dynamic brain states in 200 patients with pmTBI (ages 8-18 years, median = 14 years) at the subacute (∼1-week post-injury) and early chronic (∼ 4 months post-injury) stages, and in 179 age- and sex-matched healthy controls (HC). A k-means clustering analysis was applied to the dominant time-varying phase coherence patterns to obtain dynamic brain states. In addition, correlations between brain signals were computed as measures of static functional connectivity. Dynamic connectivity analyses showed that patients with pmTBI spend less time in a frontotemporal default mode/limbic brain state, with no evidence of change as a function of recovery post-injury. Consistent with models showing traumatic strain convergence in deep grey matter and midline regions, static interhemispheric connectivity was affected between the left and right precuneus and thalamus, and between the right supplementary motor area and contralateral cerebellum. Changes in static or dynamic connectivity were not related to symptom burden or injury severity measures, such as loss of consciousness and post-traumatic amnesia. In aggregate, our study shows that brain dynamics are altered up to 4 months after pmTBI, in brain areas that are known to be vulnerable to TBI. Future longitudinal studies are warranted to examine the significance of our findings in terms of long-term neurodevelopment.
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Affiliation(s)
| | - Josef M Ling
- The Mind Research Network/LBERI, Albuquerque, NM 87106
| | - Tracey V Wick
- The Mind Research Network/LBERI, Albuquerque, NM 87106
| | - Andrew B Dodd
- The Mind Research Network/LBERI, Albuquerque, NM 87106
| | | | | | - Vadim Zotev
- The Mind Research Network/LBERI, Albuquerque, NM 87106
| | | | | | - Joana Cabral
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | | | - Richard A Campbell
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131
| | - Robert E Sapien
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM 87131
| | - Andrew R Mayer
- The Mind Research Network/LBERI, Albuquerque, NM 87106; Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131; Department of Psychology, University of New Mexico, Albuquerque, NM 87131; Department of Neurology, University of New Mexico, Albuquerque, NM 87131
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31
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Mayer AR, Dodd AB, Robertson-Benta CR, Zotev V, Ryman SG, Meier TB, Campbell RA, Phillips JP, van der Horn HJ, Hogeveen J, Tarawneh R, Sapien RE. Multifaceted neural and vascular pathologies after pediatric mild traumatic brain injury. J Cereb Blood Flow Metab 2024; 44:118-130. [PMID: 37724718 PMCID: PMC10905640 DOI: 10.1177/0271678x231197188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/01/2023] [Accepted: 07/25/2023] [Indexed: 09/21/2023]
Abstract
Dynamic changes in neurodevelopment and cognitive functioning occur during adolescence, including a switch from reactive to more proactive forms of cognitive control, including response inhibition. Pediatric mild traumatic brain injury (pmTBI) affects these cognitions immediately post-injury, but the role of vascular versus neural injury in cognitive dysfunction remains debated. This study consecutively recruited 214 sub-acute pmTBI (8-18 years) and age/sex-matched healthy controls (HC; N = 186), with high retention rates (>80%) at four months post-injury. Multimodal imaging (functional MRI during response inhibition, cerebral blood flow and cerebrovascular reactivity) assessed for pathologies within the neurovascular unit. Patients exhibited increased errors of commission and hypoactivation of motor circuitry during processing of probes. Evidence of increased/delayed cerebrovascular reactivity within motor circuitry during hypercapnia was present along with normal perfusion. Neither age-at-injury nor post-concussive symptom load were strongly associated with imaging abnormalities. Collectively, mild cognitive impairments and clinical symptoms may continue up to four months post-injury. Prolonged dysfunction within the neurovascular unit was observed during proactive response inhibition, with preliminary evidence that neural and pure vascular trauma are statistically independent. These findings suggest pmTBI is characterized by multifaceted pathologies during the sub-acute injury stage that persist several months post-injury.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/LBERI, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Andrew B Dodd
- The Mind Research Network/LBERI, Albuquerque, NM, USA
| | | | - Vadim Zotev
- The Mind Research Network/LBERI, Albuquerque, NM, USA
| | | | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard A Campbell
- Department of Psychiatry & Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - John P Phillips
- The Mind Research Network/LBERI, Albuquerque, NM, USA
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | | | - Jeremy Hogeveen
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Rawan Tarawneh
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Robert E Sapien
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
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Moore S, Musgrave C, Sandler J, Bradley B, Jones JRA. Early intervention treatment in the first 2 weeks following concussion in adults: A systematic review of randomised controlled trials. Phys Ther Sport 2024; 65:59-73. [PMID: 38065015 DOI: 10.1016/j.ptsp.2023.11.005] [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: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE International guidelines support a repertoire of therapeutic interventions that may assist recovery following concussion. We aimed to systematically review the efficacy of early pharmacological and non-pharmacological interventions initiated within two weeks of injury on symptoms and functional recovery of adults with concussion. METHODS We conducted a Systematic Review (SR) of Randomised Controlled Trials (RCTs) without meta-analysis utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed of four databases. Study inclusion criteria were adult participants diagnosed with concussion and commencing active intervention within 14 days of injury. RESULTS AND CONCLUSIONS Of 7531 studies identified, 11 were included in the final review. Six studies were rated as high-risk of bias, three with some concerns and two as low-risk of bias. We found no evidence to support specific pharmacotherapeutic management to hasten the natural recovery time-course. Two studies reported significant improvement in selected concussion symptoms following manual therapy (at 48-72 hours post-treatment) or telephone counselling interventions (at 6 months post-injury). No high quality RCTs demonstrate superior effects of early therapeutic interventions on concussion recovery in the first 2 weeks. We advocate future research to examine impacts of health-clinician contact points aligned with symptom-specific interventions.
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Affiliation(s)
- Sonya Moore
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia.
| | - Chris Musgrave
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan Sandler
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Ben Bradley
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer R A Jones
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia; Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia; Institute of Breathing and Sleep, Heidelberg, Victoria, Australia
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Zeldovich M, Krol L, Timmermann D, Krenz U, Arango-Lasprilla JC, Gioia G, Brockmann K, Koerte IK, Buchheim A, Roediger M, Kieslich M, von Steinbuechel N, Cunitz K. Psychometric evaluation and reference values for the German Postconcussion Symptom Inventory (PCSI-SR8) in children aged 8-12 years. Front Neurol 2023; 14:1266828. [PMID: 38046588 PMCID: PMC10693295 DOI: 10.3389/fneur.2023.1266828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background Post-concussion symptoms (PCS) are a common consequence of pediatric traumatic brain injury (pTBI). They include cognitive, emotional, and physical disturbances. To address the lack of age-adapted instruments assessing PCS after pTBI, this study examines the psychometric properties of the German 17-item post-TBI version of the Postconcussion Symptom Inventory (PCSI-SR8) in children aged 8-12 years. The study also aims to establish reference values based on data from a pediatric general population sample to better estimate the prevalence and clinical relevance of PCS after pTBI in clinical and research settings. Methods A total of 132 children aged 8-12 years from a post-acute TBI sample and 1,047 from a general population sample were included in the analyses. The questionnaire was translated from English into German and linguistically validated using forward and backward translation and cognitive debriefing to ensure comprehensibility of the developed version. Reliability and validity were examined; descriptive comparisons were made with the results of the English study. Measurement invariance (MI) analyses between TBI and general population samples were conducted prior to establishing reference values. Factors contributing to the total and scale scores of the PCSI-SR8 were identified using regression analyses. Reference values were calculated using percentiles. Results Most children (TBI: 83%; general population: 79%) rated at least one symptom as "a little" bothersome. The German PCSI-SR8 met the psychometric assumptions in both samples and was comparable to the English version. The four-factor structure comprising physical, emotional, cognitive, and fatigue symptoms could be replicated. The MI assumption was retained. Therefore, reference values could be provided to determine the symptom burden of patients in relation to a comparable general population. Clinical relevance of reported symptoms is indicated by a score of 8, which is one standard deviation above the mean of the general population sample. Conclusion The German version of the PCSI-SR8 is suitable for assessment of PCS after pTBI. The reference values allow for a more comprehensive evaluation of PCS following pTBI. Future research should focus on validation of the PCSI-SR8 in more acute phases of TBI, psychometric examination of the pre-post version, and child-proxy comparisons.
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Affiliation(s)
- Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Leonie Krol
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Dagmar Timmermann
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Ugne Krenz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Gerard Gioia
- Division of Pediatric Neuropsychology, Safe Concussion Outcome Recovery and Education Program, Children's National Health System, Department of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Rockville, MA, United States
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Inga K. Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Maike Roediger
- Department of Pediatric and Adolescent Medicine- General Pediatrics- Intensive Care Medicine and Neonatology, University Hospital Muenster, Muenster, Germany
| | - Matthias Kieslich
- Department of Paediatric Neurology, Goethe-University Frankfurt/Main, Frankfurt, Germany
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Katrin Cunitz
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
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Jaganathan KS, Sullivan KA, Greenslade J, McMahon KL, Mitchell G, Kerr G. Understanding the Sociocognitive Determinants Underlying Intentions to Exercise for Postconcussion Symptom Relief: An Application of the Theory of Planned Behavior. J Sport Rehabil 2023; 32:873-883. [PMID: 37591504 DOI: 10.1123/jsr.2023-0017] [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: 01/17/2023] [Revised: 05/19/2023] [Accepted: 06/19/2023] [Indexed: 08/19/2023]
Abstract
CONTEXT This study investigated individual sociocognitive factors from the theory of planned behavior and their relationship to exercise for postconcussion recovery. DESIGN AND METHODS Four hundred and fifty-nine Australian adults, two-thirds of whom had no concussion history (66%), completed an online survey of their beliefs and attitudes toward exercise for postconcussion recovery. Secondary questions evaluated program design features that could affect engagement (eg, session frequency). RESULTS Structured equation modeling found that subjective norms were the strongest significant predictor of intention to participate in exercise for postconcussion recovery. Perceived behavioral control was also a significant predictor of intention to participate but to a lesser extent. Attitude did not predict participation intention. The design features identified as key were personalization and being supervised during the program. CONCLUSIONS This study found that people's intention to participate in a program of exercise postconcussion recovery is shaped by individual psychological factors and identified program design features that could be adjusted for increased engagement. Program success could be maximized through strategies such as supporting individuals to have a stronger sense of control over their participation through the choice of session timing or frequency and harnessing the influence of significant others via supportive messaging from key professionals.
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Affiliation(s)
| | - Karen A Sullivan
- School of Psychology & Counselling, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane,Australia
| | - Jamie Greenslade
- School of Public Health and Social Work, Queensland University of Technology, Brisbane,Australia
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane,Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane,Australia
| | - Gary Mitchell
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane,Australia
| | - Graham Kerr
- School of Exercise & Nutrition Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane,Australia
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Rovt J, Xu S, Dutrisac S, Ouellet S, Petel O. A technique for in situ intracranial strain measurement within a helmeted deformable headform. J Mech Behav Biomed Mater 2023; 147:106140. [PMID: 37778168 DOI: 10.1016/j.jmbbm.2023.106140] [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: 01/12/2023] [Revised: 05/03/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
Despite the broad use of helmets, incidence of concussion remains high. Current methods for helmet evaluation focus on the measurement of head kinematics as the primary tool for quantifying risk of brain injury. Though the primary cause of mild Traumatic Brain Injury (mTBI) is thought to be intracranial strain, helmet testing methodologies are not able to directly resolve these parameters. Computational injury models and impact severity measures are currently used to approximate intracranial strains from head kinematics and predict injury outcomes. Advancing new methodologies that enable experimental intracranial strain measurements in a physical model would be useful in the evaluation of helmet performance. This study presents a proof-of-concept head surrogate and novel helmet evaluation platform that allows for the measurement of intracranial strain using high-speed X-ray digital image correlation (XDIC). In the present work, the head surrogate was subjected to a series of bare and helmeted impacts using a pneumatically-driven linear impactor. Impacts were captured at 5,000 fps using a high-speed X-ray cineradiography system, and strain fields were computed using digital image correlation. This test platform, once validated, will open the door to using brain tissue-level measurements to evaluate helmet performance, providing a tool that can be translated to represent mTBI injury mechanisms, benefiting the helmet design processes.
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Affiliation(s)
- Jennifer Rovt
- Carleton University, Department of Mechanical and Aerospace Engineering, Ottawa, K1S 5B6, ON, Canada
| | - Sheng Xu
- Carleton University, Department of Mechanical and Aerospace Engineering, Ottawa, K1S 5B6, ON, Canada
| | - Scott Dutrisac
- Carleton University, Department of Mechanical and Aerospace Engineering, Ottawa, K1S 5B6, ON, Canada
| | - Simon Ouellet
- Defence Research and Development Canada Valcartier, Québec, C3J 1X5, QC, Canada
| | - Oren Petel
- Carleton University, Department of Mechanical and Aerospace Engineering, Ottawa, K1S 5B6, ON, Canada.
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36
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Sullivan KA. Recovery after traumatic brain injury: An integrative review of the role of social factors on postinjury outcomes. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:772-779. [PMID: 35508420 DOI: 10.1080/23279095.2022.2070021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This research is an integrative review of the literature on social factors in TBI outcomes. It examines how such factors have been framed in TBI models, the social experience of people post-injury, and the evidence for effective social interventions. Evidence suggests that even when physical functioning has improved after injury, there is a lingering social distress that leaves individuals isolated and functionally impaired. A novel hypothesis is proposed to explain why these difficulties persist. This hypothesis draws from existing biopsychosocial models of TBI recovery, including those prominent in neuropsychology. It is argued that the social component of several TBI outcome models is too narrowly defined. This potentially has the effect of focusing efforts on the individual and their social skills or abilities as opposed to the seeking improvements at the level of the community. Evidence for and against this hypothesis is considered. This evaluation supports the idea that TBI outcomes are subject to a wider range of post injury social factors than is typically recognized, and that these factors are dynamic rather than static. Inspired by this hypothesis, this review proposes that social interventions for TBI should be adjusted to suit the stage of recovery.
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Affiliation(s)
- Karen A Sullivan
- School of Psychology and Counselling, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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Almalki SF, Zakaria OM, Almousa AS, Alwadany MM. Knowledge, Attitude, and Behavior of Medical Students with Regard to Concussions: A Cross-Sectional Study. Cureus 2023; 15:e47112. [PMID: 38022325 PMCID: PMC10646687 DOI: 10.7759/cureus.47112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Concussions, categorized as mild traumatic brain injuries, result from traumatic events and present a significant concern within the field of traumatic brain injuries. Understanding the multifaceted pathophysiology of concussions, their diverse symptomatology, and their appropriate management strategies is crucial for healthcare professionals. This study explores the knowledge, attitudes, and behaviors of medical students at King Faisal University in the Eastern Province of Saudi Arabia regarding concussions. METHODS A cross-sectional study design was employed to assess a diverse group of medical students at King Faisal University in the Eastern Province of Saudi Arabia. Participants were surveyed using a questionnaire covering socio-demographic information, knowledge assessment, attitude assessment, and behavior assessment. RESULTS Of the 315 participants, 68.3% demonstrated good knowledge about concussions. Participants generally recognized concussions as a type of traumatic brain injury (68.9%) and believed it was necessary to report concussion symptoms to a doctor (80.3%). However, certain misconceptions existed, such as the belief that all patients with concussion should rest for seven days (31.7%). Participants primarily obtained information from teachers (100%) and the internet and social media (81.6%). CONCLUSION While medical students at King Faisal University in the Eastern Province of Saudi Arabia generally exhibited good knowledge about concussions, specific knowledge gaps and misconceptions were seen to exist. To ensure comprehensive understanding and promote appropriate management, continuous education, and awareness campaigns are essential, with healthcare providers playing a pivotal role in knowledge dissemination.
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Bunt SC, LoBue C, Hynan LS, Didehbani N, Stokes M, Miller SM, Bell K, Cullum CM. Early vs. delayed evaluation and persisting concussion symptoms during recovery in adults. Clin Neuropsychol 2023; 37:1410-1427. [PMID: 36083237 DOI: 10.1080/13854046.2022.2119165] [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: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
Objective: Persisting concussion symptoms may adversely affect return to work and functioning in daily activities. This study compared adults who were initially evaluated < 30 days versus those evaluated ≥ 30 days following a concussion at a specialty concussion clinic to determine if delayed initial evaluation is associated with persisting symptoms during recovery. Method: Participants (N = 205) 18 years of age and older who sustained a concussion and presented to a North Texas Concussion Registry (ConTex) clinic were evaluated at two time points: initial clinical visit and three-month follow-up. Participants provided medical history, injury related information, and completed the Sport Concussion Assessment Tool-5 Symptom Evaluation, Generalized Anxiety Disorder 7-item scale (GAD-7), and Patient Health Questionnaire (PHQ-8). Participants were divided into two groups: early and delayed evaluation (±30 days post injury). Results: Number and severity of concussion symptoms were similar between both groups at their initial clinical visit. However, linear regression models showed that a delayed clinical evaluation was associated with a greater number and severity of concussion symptoms along with greater aggravation of symptoms from physical and cognitive activity at three-month follow-up. Conclusions: Individuals who sought care at specialty concussion clinics regardless of previous care 30 or more days following their injury reported more serious persisting concussion symptoms at three month follow-up than those who sought care sooner. Education to improve adults' recognition of concussions when they occur and obtaining earlier clinical evaluation may represent important opportunities in promoting better recovery and reducing persisting concussion symptoms.
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Affiliation(s)
- Stephen C Bunt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, UT Southwestern Medical Center Dallas, TX, USA
| | - Linda S Hynan
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mathew Stokes
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shane M Miller
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Sports Medicine, Scottish Rite for Children, Dallas, TX, USA
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, UT Southwestern Medical Center Dallas, TX, USA
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
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Jensen KL, Wachner LG, Storm van den Brekel J, Hardis H, Smaakjær P, Hansen MV, Turn J, Rasmussen RS. Multidisciplinary interventions increase weekly working hours and quality of life in persons with post-concussion syndrome. Neurol Res 2023; 45:926-935. [PMID: 37590325 DOI: 10.1080/01616412.2023.2247302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES To improve labor market attachment, general health and quality of life in persons suffering from post-concussion syndrome. Labor market attachment often changes after mTBI, and especially in persons suffering from post-concussion syndrome, and constitutes a huge societal burden. METHODS Eighty-two adults with persistent post-concussion syndrome participated in this single-center and uncontrolled interventional efficacy open-label investigation. The primary endpoint was to increase weekly working hours. Outcome measures ranged from self-reported cognitive symptoms to objective performance testing. Multidisciplinary interventions were used to reduce symptoms of fatigue, stress, pain, oculomotor malfunction, and sensitivity to both sound and light. RESULTS Workhours improved from median 0 to 6 hours (p = 0.00002). Several significant improvements were observed in quality of life measured by the SF-36. General fatigue measured by the MFI-20 was reduced (p < 0.0001), and symptoms of depression were reduced (p < 0.0001). The COPM results were improved for task completion satisfaction and for ability to perform a task (p < 0.0001). Reading speed, and performances in the Groffman Visual Tracing Test and the King-Devick Test, all improved (p < 0.01). The intervention did not reduce perception of pain intensity (p = 0.11). CONCLUSION After the intervention, participants increased weekly workhours and improved in many aspects of life - including quality of life, performance in everyday activities, fatigue and depression. Perception of pain intensity was not improved.
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Affiliation(s)
- Katrine L Jensen
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Lone G Wachner
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | | | - Helle Hardis
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Peter Smaakjær
- Department of Vision, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Mette V Hansen
- Department of Hearing, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Janette Turn
- Department of Hearing, CSU-Slagelse, Center of Communication, Slagelse, Denmark
| | - Rune S Rasmussen
- Department of Speech & Brain Pathology, CSU-Slagelse, Center of Communication, Slagelse, Denmark
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Aviv I, Shorer M, Fennig S, Aviezer H, Singer-Harel D, Apter A, Pilowsky Peleg T. From acute stress to persistent post-concussion symptoms: The role of parental accommodation and child's coping strategies. Clin Neuropsychol 2023; 37:1389-1409. [PMID: 36416168 DOI: 10.1080/13854046.2022.2145578] [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: 07/01/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
Background: Acute stress following mild Traumatic Brain Injury (mTBI) is highly prevalent and associated with Persistent Post-Concussion symptoms (PPCS). However, the mechanism mediating this relationship is understudied. Objective: To examine whether parental accommodation (i.e. parents' attempts to adjust the environment to the child's difficulties) and child's coping strategies mediate the association between acute stress and PPCS in children following mTBI. Method: Participants were 58 children aged 8-16 who sustained a mTBI and their parents. Children's acute stress (one-week post-injury) and coping strategies (three weeks post-injury), and parental accommodation (three weeks and four months post-injury) were assessed. Outcome measures included PPCS (four months post-injury) and neuropsychological tests of cognitive functioning (attention and memory). A baseline for PPCS was obtained by a retrospective report of pre-injury symptoms immediately after the injury. Results: Children's acute stress and negative coping strategies (escape-oriented coping strategies) and four-months parental accommodation were significantly related to PPCS. Acute stress predicted PPCS and attention and memory performance. Parental accommodation significantly mediated the association between acute stress and PPCS. Conclusions: Stress plays an important role in children's recovery from mTBI and PPCS. Parental accommodation mediates this relationship, and thus, clinical attention to parental reactions during recovery is needed.
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Affiliation(s)
- Irit Aviv
- Department of Psychology, The Hebrew University, Jerusalem, Israel
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Maayan Shorer
- Department of Psychology, Ruppin Academic Center, Emek-Hefer, Israel
| | - Silvana Fennig
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Hillel Aviezer
- Department of Psychology, The Hebrew University, Jerusalem, Israel
| | - Dana Singer-Harel
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Alan Apter
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Tammy Pilowsky Peleg
- Department of Psychology, The Hebrew University, Jerusalem, Israel
- The Neuropsychological Unit, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
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Meusel LA, Colella B, Ruttan L, Tartaglia MC, Green R. Preliminary efficacy and predictors of response to a remotely-delivered symptom self-management program for persistent symptoms after concussion. Brain Inj 2023; 37:1245-1252. [PMID: 37452884 DOI: 10.1080/02699052.2023.2230873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/07/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND More than a quarter of adults with concussion endure prolonged symptoms of >3 months. We developed the Concussion Education Self-Management program to help people manage persisting symptoms. Here, we assess feasibility, preliminary efficacy, and correlates of response. METHODS N = 80 adults participated in the program; ages ranged from 18 to 65 years and time post-injury ranged from 6 months to 18 years. Weekly sessions, delivered remotely and in groups, comprised education and strategies for management of cognitive, emotional, and physical symptoms. Primary outcome: Confidence to self-manage symptoms. Secondary outcomes: Quality of life; mood/anxiety/stress. Predictors of response: Self-reported cognitive, emotional and physical symptoms at intake. RESULTS Pre- to post-program improvements were observed in confidence to self-manage, p < 0.03; quality of life, p < 0.001; depression, p < 0.001; anxiety, p < 0.001; and stress, p < 0.001. Considering confidence to self-manage, those with fewer cognitive and physical symptoms benefitted more (p's < 0.0005 and p < 0.01, respectively). DISCUSSION This program shows promise for improving self-management of prolonged symptoms. Those with high symptom burden may need extra sessions to benefit. This is a cost-effective and scalable program that can reach people regardless of geographic location or impediments to travel.
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Affiliation(s)
- Liesel-Ann Meusel
- Toronto Rehab, University Centre, University Health Network, Toronto, Canada
| | - Brenda Colella
- Toronto Rehab, University Centre, University Health Network, Toronto, Canada
| | - Lesley Ruttan
- Toronto Rehab, University Centre, University Health Network, Toronto, Canada
| | | | - Robin Green
- Toronto Rehab, University Centre, University Health Network, Toronto, Canada
- Psychiatry, University of Toronto, Toronto, Canada
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Bennett R, Sullivan KA. A psychometric evaluation of a new social subscale for the Common Misconceptions about Traumatic Brain Injury (CM-TBI) questionnaire: toward the CM-TBI-II. Brain Inj 2023; 37:1253-1261. [PMID: 37525435 DOI: 10.1080/02699052.2023.2237891] [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: 08/26/2022] [Revised: 05/18/2023] [Accepted: 05/27/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Existing TBI misconception measures are critiqued for failing to measure postinjury social experiences. This study developed a social subscale for the Common Misconceptions about TBI (CM-TBI) questionnaire for use in the general public. METHODS Seven experts independently review items drawn from the literature. Shortlisted items were administered online to 158 adults (aged ≥18 years; 51% postschool educated; 60% no TBI experience), the CM-TBI, and a measure of construct validity (a published TBI-adaptation of the Community Attitudes Towards the Mentally Ill; CAMI-TBI). One week later, the new items were redeployed (n = 46). RESULTS Expert review and iterative correlations identified a 10-item social subscale (internal consistency, test-retest reliability, α's>.80). When added to the CM-TBI (ie. CM-TBI-II), the internal consistency was .71. The social subscale was significantly correlated with CAMI-TBI measures (p's <.05, r's > .3). There was no significant difference on the social subscale for education subgroups (school vs post-school, p = 0.056) or previous TBI experience; but there was a difference for the CM-TBI-II (post-school>school; Cohen's d = 7.83, large effect). CONCLUSION This study found strong preliminary psychometric support for a new social subscale, administered as the CM-TBI-II. This subscale shows promise as a measure of misconceptions about social functioning post-TBI. The CM-TBI-II could support evaluations of programs aiming to improve social engagement and community participation for people with TBI.
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Affiliation(s)
- Ryleigh Bennett
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karen A Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
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Aderman MJ, Brett BL, Ross JD, Malvasi SR, McGinty G, Jackson JC, Estevez CA, Brodeur RM, Svoboda SJ, McCrea MA, Broglio SP, McAllister TW, Pasquina PF, Cameron KL, Roach MH. Association Between Symptom Cluster Endorsement at Initiation of a Graduated Return-to-Activity Protocol and Time to Return to Unrestricted Activity After Concussion in United States Service Academy Cadets. Am J Sports Med 2023; 51:2996-3007. [PMID: 37551673 DOI: 10.1177/03635465231189211] [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] [Indexed: 08/09/2023]
Abstract
BACKGROUND The endorsement of symptoms upon initiation of a graduated return-to-activity (GRTA) protocol has been associated with prolonged protocols. It is unclear whether there are specific symptom clusters affecting protocol durations. PURPOSE To describe the endorsement of specific concussion symptom clusters at GRTA protocol initiation and examine the association between symptom cluster endorsement and GRTA protocol duration. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS This study was conducted among cadets enrolled at 3 US service academies. Participants completed an evaluation upon GRTA protocol initiation. Participants endorsing symptoms were binarized based on 6 symptom clusters (cognitive, emotional, insomnia, physical, sensitivity, and ungrouped). The primary outcome of interest was GRTA protocol duration based on symptom cluster endorsement severity. Prevalence rates were calculated to describe symptom cluster endorsement. Kaplan-Meier survival estimates and univariate and multivariable Cox proportional hazards regression models were calculated for all 6 symptom clusters to estimate GRTA protocol duration while controlling for significant covariates. RESULTS Data from 961 concussed participants were analyzed. Of these, 636 participants were asymptomatic upon GRTA protocol initiation. Among the 325 symptomatic participants, the physical symptom cluster (80%) was most endorsed, followed by the cognitive (29%), insomnia (23%), ungrouped (19%), sensitivity (15%), and emotional (9%) clusters. Univariate results revealed a significant association between endorsing cognitive (hazard ratio [HR], 0.79; p = .001), physical (HR, 0.84; p < .001), insomnia (HR, 0.83; p = .013), sensitivity (HR, 0.70; p < .001), and ungrouped (HR, 0.75; p = .005) symptom clusters and GRTA protocol duration. Endorsing physical (HR, 0.84; p < .001) and sensitivity (HR, 0.81; p = .036) clusters maintained a significant association with GRTA protocol duration in the multivariable models. CONCLUSION Participants endorsing physical or sensitivity symptom clusters displayed GRTA protocols prolonged by 16% to 19% compared with participants not endorsing that respective cluster after controlling for significant covariates.
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Affiliation(s)
- Michael J Aderman
- Keller Army Hospital, West Point, New York, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Benjamin L Brett
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Jeremy D Ross
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Steven R Malvasi
- Keller Army Hospital, West Point, New York, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Gerald McGinty
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Jonathan C Jackson
- United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Carlos A Estevez
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Rachel M Brodeur
- United States Coast Guard Academy, New London, Connecticut, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Steven J Svoboda
- MedStar Health, Washington, DC, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Michael A McCrea
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Steven P Broglio
- University of Michigan Concussion Center, Ann Arbor, Michigan, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Thomas W McAllister
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Paul F Pasquina
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Kenneth L Cameron
- Keller Army Hospital, West Point, New York, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
| | - Megan H Roach
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, Virginia, USA; Department of Clinical Investigations, Womack Army Medical Center, Fort Liberty, North Carolina, USA
- Investigation performed at Keller Army Hospital, West Point, New York, USA
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Theadom A, Mitchell T, Shepherd D. Comparing post-concussion symptom reporting between adults with and without a TBI history within an adult male correctional facility. BRAIN IMPAIR 2023; 24:333-340. [PMID: 38167192 DOI: 10.1017/brimp.2022.20] [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: 11/07/2022]
Abstract
BACKGROUND A higher proportion of people in prison have a history of traumatic brain injury (TBI) than the general population. However, little is known about potentially related persistent symptoms in this population. AIMS To compare symptom reporting in men with and without a history of TBI following admission to a correctional facility. METHODS All men transferred to the South Auckland Correctional Facility in New Zealand complete a lifetime TBI history and the Rivermead Post-Concussion Symptom Questionnaire (RPQ) as part of their routine health screen. Data collected between June 2020 and March 2021 were extracted and anonymised. Participants were classified as reporting at least one TBI in their lifetime or no TBI history. The underlying factor structure of the RPQ was determined using principal components analysis. Symptom scores between those with and without a TBI history were compared using Mann Whitney U tests. RESULTS Of the N = 363 adult male participants, 240 (66%) reported experiencing at least one TBI in their lifetime. The RPQ was found to have a two-factor structure (Factor 1: cognitive, emotional, behavioural; Factor 2: visual-ocular) explaining 61% of the variance. Men reporting a TBI history had significantly higher cognitive, emotional and behavioural (U = 50.4, p < 0.001) and visuo-ocular symptoms (U = 68.5, p < 0.001) in comparison to men reporting no TBI history. CONCLUSION A history of TBI was associated with higher symptom burden on admission to a correctional facility. Screening for TBI history and current symptoms on admission may assist prisoners experiencing persistent effects of TBI to access rehabilitation.
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Affiliation(s)
- Alice Theadom
- The TBI Network, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Tracey Mitchell
- The TBI Network, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Auckland South Correctional Facility (Kohuora), Serco, Auckland, New Zealand
| | - Daniel Shepherd
- The TBI Network, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Jennings T, Islam MS. Examining the interdisciplinary approach for treatment of persistent post-concussion symptoms in adults: a systematic review. BRAIN IMPAIR 2023; 24:290-308. [PMID: 38167190 DOI: 10.1017/brimp.2022.28] [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: 11/24/2022]
Abstract
BACKGROUND The objective of this review is to examine the evidence for the interdisciplinary approach in treatment of persistent post-concussion symptoms in adults. METHODS This systematic literature search was undertaken according to the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA) guidelines. Five electronic databases were searched: CINAHL, Informit, ProQuest, PubMed and Scopus. After screening and quality assessment, the review included six studies published in English and peer-reviewed journals, between 2011 and 2021 to return contemporary evidence. RESULTS The results revealed that there was significant variation between measures used and the timing of the pre- and post-treatment assessment. The studies found an interdisciplinary approach to be beneficial, however, the challenges of inherent heterogeneity, lack of clarity for definitions and diagnosis, and mixed results were apparent. The interdisciplinary interventions applied in all identified studies were found to reduce post-concussion symptoms across the symptom subtypes: headache/migraine, vestibular, cognitive, ocular motor and anxiety/mood. CONCLUSIONS The results demonstrated evidence for a reduction in persistent post-concussion symptoms following interdisciplinary intervention. This evidence will inform health services, clinicians, sports administrators and researchers with regard to concussion clinic and rehabilitation team design and service delivery.
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Affiliation(s)
- Tamara Jennings
- Master of Health Management, Barwon Health, Geelong 3215, Victoria, Australia
| | - Md Shahidul Islam
- School of Health, Faculty of Medicine and Health, University of New England, Armidale, New South Wales, Australia
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Kim SY, Yeh PH, Ollinger JM, Morris HD, Hood MN, Ho VB, Choi KH. Military-related mild traumatic brain injury: clinical characteristics, advanced neuroimaging, and molecular mechanisms. Transl Psychiatry 2023; 13:289. [PMID: 37652994 PMCID: PMC10471788 DOI: 10.1038/s41398-023-02569-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Mild traumatic brain injury (mTBI) is a significant health burden among military service members. Although mTBI was once considered relatively benign compared to more severe TBIs, a growing body of evidence has demonstrated the devastating neurological consequences of mTBI, including chronic post-concussion symptoms and deficits in cognition, memory, sleep, vision, and hearing. The discovery of reliable biomarkers for mTBI has been challenging due to under-reporting and heterogeneity of military-related mTBI, unpredictability of pathological changes, and delay of post-injury clinical evaluations. Moreover, compared to more severe TBI, mTBI is especially difficult to diagnose due to the lack of overt clinical neuroimaging findings. Yet, advanced neuroimaging techniques using magnetic resonance imaging (MRI) hold promise in detecting microstructural aberrations following mTBI. Using different pulse sequences, MRI enables the evaluation of different tissue characteristics without risks associated with ionizing radiation inherent to other imaging modalities, such as X-ray-based studies or computerized tomography (CT). Accordingly, considering the high morbidity of mTBI in military populations, debilitating post-injury symptoms, and lack of robust neuroimaging biomarkers, this review (1) summarizes the nature and mechanisms of mTBI in military settings, (2) describes clinical characteristics of military-related mTBI and associated comorbidities, such as post-traumatic stress disorder (PTSD), (3) highlights advanced neuroimaging techniques used to study mTBI and the molecular mechanisms that can be inferred, and (4) discusses emerging frontiers in advanced neuroimaging for mTBI. We encourage multi-modal approaches combining neuropsychiatric, blood-based, and genetic data as well as the discovery and employment of new imaging techniques with big data analytics that enable accurate detection of post-injury pathologic aberrations related to tissue microstructure, glymphatic function, and neurodegeneration. Ultimately, this review provides a foundational overview of military-related mTBI and advanced neuroimaging techniques that merit further study for mTBI diagnosis, prognosis, and treatment monitoring.
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Affiliation(s)
- Sharon Y Kim
- School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
| | - Ping-Hong Yeh
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - John M Ollinger
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Herman D Morris
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Maureen N Hood
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Vincent B Ho
- Department of Radiology and Radiological Sciences, Uniformed Services University, Bethesda, MD, USA
- Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Kwang H Choi
- Program in Neuroscience, Uniformed Services University, Bethesda, MD, USA.
- Center for the Study of Traumatic Stress, Uniformed Services University, Bethesda, MD, USA.
- Department of Psychiatry, Uniformed Services University, Bethesda, MD, USA.
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Kleffelgård I, Andelic N, Bruusgaard KA, Langhammer B, Tamber AL, Soberg HL. Dizziness-Related Disability One Year after a Mild-to-Moderate TBI-A Follow-Up Study. J Clin Med 2023; 12:5192. [PMID: 37629234 PMCID: PMC10455561 DOI: 10.3390/jcm12165192] [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: 06/21/2023] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Persisting dizziness and balance problems after mild-to-moderate traumatic brain injury (mmTBI) may result in considerable disability. The primary aim of this study was to explore the factors associated with dizziness-related disability one year post-injury. Data from 64 participants (mean age 39.4 [SD 13.0] years; 45 [70.3%] women) with mmTBI from a previous randomised controlled trial were analysed using simple and multiple regression analyses (Clinical Trials Registry #NCT01695577). The Dizziness Handicap Inventory one year (12.1, [SD1.6] months) post-injury was the dependent variable. Demographic and injury-related variables, clinical findings, and measures of post-injury symptoms and functioning (Rivermead Post-Concussion Symptoms Questionnaire, RPQ; Vertigo Symptom Scale-short form, VSS-SF; Hospital Anxiety and Depression Scale; Balance Error Scoring System; and High-Level Mobility Assessment Tool, HiMAT) at baseline (3.5 [SD 2.1] months post-injury) were the independent variables. Dizziness-related disability at one year was associated with pre-injury comorbidity, neck pain, higher RPQ, higher VSS-SF, and lower HiMAT scores (adjusted R2 = 0.370, F = 6.52 p < 0.001). In conclusion, the factors associated with dizziness-related disability one year post-injury, such as pre-injury comorbidity, neck pain, increased post-concussion symptom burden, increased dizziness symptom severity, and reduced balance and mobility, should be addressed early in the rehabilitation process to reduce patient burden.
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Affiliation(s)
- Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (N.A.); (H.L.S.)
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (N.A.); (H.L.S.)
- Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Kari Anette Bruusgaard
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (K.A.B.); (B.L.); (A.-L.T.)
| | - Birgitta Langhammer
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (K.A.B.); (B.L.); (A.-L.T.)
| | - Anne-Lise Tamber
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (K.A.B.); (B.L.); (A.-L.T.)
| | - Helene Lundgaard Soberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway; (N.A.); (H.L.S.)
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (K.A.B.); (B.L.); (A.-L.T.)
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48
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Wright B, Guilliod R, Thakur B, Kundig C, Morales J, Tessler J, Berry J, Zhang R, Bell KR, Pinto SM. Hyperbaric Oxygen Therapy versus placebo for post-concussion syndrome (HOT-POCS): A randomized, double-blinded controlled pilot study. Contemp Clin Trials Commun 2023; 34:101176. [PMID: 37416626 PMCID: PMC10320499 DOI: 10.1016/j.conctc.2023.101176] [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: 02/15/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023] Open
Abstract
Post-Concussion Syndrome (PCS) refers to the persistence of physical, cognitive, and emotional symptoms following mild traumatic brain injury (mTBI)/concussion, occurring in roughly 15-30% of individuals. Hyperbaric oxygen therapy (HBOT) has been suggested as a potential treatment for PCS; however, the evidence to date is mixed due to inconsistencies in the treatment protocol and focus on veterans with combat-related injuries, which may not be generalizable to the general population. The goal of Hyperbaric Oxygen Therapy for Post-Concussion Syndrome (HOT-POCS) is to assess the efficacy and safety of HBOT for the treatment of PCS in the civilian population. This randomized, controlled pilot study will be using a standardized HBOT protocol (20 sessions of 100% O2 at 2.0 atm absolute [ATA]) compared with a true placebo gas system that mimics the oxygen composition at room air (20 sessions of 10.5% O2 and 89.5% nitrogen at 2.0 ATA) in a cohort of 100 adults with persistent post-concussive symptoms 3-12 months following injury. Change in symptoms on the Rivermead Post-concussion Questionnaire (RPQ) will be the primary outcome of interest. Secondary outcomes include the rate of adverse events, change in the quality of life, and change in cognitive function. Exploratory outcome measures will include changes in physical function and changes in cerebral brain perfusion and oxygen metabolism on MRI brain imaging. Overall, the HOT-POCS study will compare the efficacy of a standardized HBOT treatment protocol against a true placebo gas for the treatment of PCS within 12 months after injury.
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Affiliation(s)
- Brittany Wright
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Renie Guilliod
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bhaskar Thakur
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Charles Kundig
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jill Morales
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph Tessler
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Berry
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rong Zhang
- Departments of Neurology and Internal Medicine, University of Texas Southwestern Medical Center, Director of Cerebrovascular Laboratory, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, Dallas, TX, USA
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shanti M. Pinto
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA
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49
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Leung ONW, Chiu NKH, Wong SYS, Cuijpers P, Alonso J, Chan PKS, Lui G, Wong E, Bruffaerts R, Yip BHK, Mortier P, Vilagut G, Kwok D, Lam LCW, Kessler RC, Mak ADP. Dimensional structure of one-year post-COVID-19 neuropsychiatric and somatic sequelae and association with role impairment. Sci Rep 2023; 13:12205. [PMID: 37500708 PMCID: PMC10374659 DOI: 10.1038/s41598-023-39209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
This study examined the latent structure of the broad range of complex neuropsychiatric morbidities occurring 1 year after COVID-19 infection. As part of the CU-COVID19 study, 248 (response rate=39.3%) of 631 adults hospitalized for COVID-19 infection in Hong Kong completed an online survey between March-2021 and January-2022. Disorder prevalence was compared against a random non-infected household sample (n=1834). 248 surveys were received on average 321 days post-infection (Mean age: 48.9, 54% female, moderate/severe/critical infection: 58.2%). 32.4% were screened to have at least one mental disorder, 78.7% of whom had concurrent fatigue/subjective cognitive impairment (SCI). Only PTSD (19.1%) was significantly more common than control (14%, p=0.047). Latent profile analysis classified individuals into P1 (12·4%)-no current neuropsychiatric morbidities, P2 (23.1%)-SCI/fatigue, P3 (45.2%)-anxiety/PTSD, P4 (19.3%)-depression. SCI and fatigue pervaded in all profiles (P2-4) with neuropsychiatric morbidities one-year post-infection. PTSD, anxiety and depressive symptoms were most important in differentiating P2-4. Past mental health and P4 independently predicted functional impairment. Neuropsychiatric morbidity was associated with past mental health, reduced resilience, financial problems, but not COVID-19 severity. Their confluence with depressive and anxiety symptoms predicted impairment and are associated with psychological and environmental factors.
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Affiliation(s)
- Owen N W Leung
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Nicholas K H Chiu
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Jordi Alonso
- Health Services Research group, IMIM-Institut Hospital Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, CIBERESP, Barcelona, Spain
| | - Paul K S Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Grace Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eliza Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Philippe Mortier
- Health Services Research group, IMIM-Institut Hospital Mar d'Investigacions Mèdiques, CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain
| | - Gemma Vilagut
- Health Services Research group, IMIM-Institut Hospital Mar d'Investigacions Mèdiques, CIBER Epidemiología y Salud Pública CIBERESP, Barcelona, Spain
| | - Dora Kwok
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Linda C W Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Arthur D P Mak
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
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50
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Faulkner JW, Theadom A, Snell DL, Williams MN. Network analysis applied to post-concussion symptoms in two mild traumatic brain injury samples. Front Neurol 2023; 14:1226367. [PMID: 37545717 PMCID: PMC10398392 DOI: 10.3389/fneur.2023.1226367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023] Open
Abstract
Objective A latent disease explanation cannot exclusively explain post-concussion symptoms after mild traumatic brain injury (mTBI). Network analysis offers an alternative form of explanation for relationships between symptoms. The study aimed to apply network analysis to post-concussion symptoms in two different mTBI cohorts; an acute treatment-seeking sample and a sample 10 years post-mTBI. Method The treatment-seeking sample (n = 258) were on average 6 weeks post-injury; the 10 year post mTBI sample (n = 193) was derived from a population-based incidence and outcomes study (BIONIC). Network analysis was completed on post-concussion symptoms measured using the Rivermead Post-Concussion Questionnaire. Results In the treatment-seeking sample, frustration, blurred vision, and concentration difficulties were central to the network. These symptoms remained central in the 10 year post mTBI sample. A Network Comparison Test revealed evidence of a difference in network structure across the two samples (p = 0.045). However, the only symptoms that showed significant differences in strength centrality across samples were irritability and restlessness. Conclusion The current findings suggest that frustration, blurred vision and concentration difficulties may have an influential role in the experience and maintenance of post-concussion symptoms. The impact of these symptoms may remain stable over time. Targeting and prioritising the management of these symptoms may be beneficial for mTBI rehabilitation.
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Affiliation(s)
- Josh W. Faulkner
- Te Herenga Waka – Victoria University of Wellington, Wellington, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Auckland, New Zealand
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