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Leland A, Tavakol K, Scholten J, Libin AV, Mathis D, Maron D, Bakhshi S. Affective and Cognitive Conditions are Stronger Predictors of Success with Community Reintegration than Gait and Balance Performance in Veterans with Mild Traumatic Brain Injury. Med Arch 2018; 71:417-423. [PMID: 29416203 PMCID: PMC5788509 DOI: 10.5455/medarh.2017.71.417-423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Optimal community reintegration is an integral part of the clinical management of patients with mild traumatic brain injury. Background/Objective We sought the contribution and inter-relation of such variables as balance, executive function, and affective regulation to the community reintegration of veterans with mTBI. Methods We examined the statistical relationship among the above variables by conducting a series of objective evaluations to assess the balance, gait, executive function, affective regulation, and scores representing the patients’ issues with community reintegration. The data were statistically analyzed for correlation and regression. Results High correlation was found among scores for balance and gait, executive function and affective regulation. The first and second best predictors of success with patient’s community reintegration were data representing affective regulation and cognitive impairments, respectively. However, the data for dynamic balance correlated weakly and insignificantly with scores for the three subsets of community reintegration. Conclusions We revealed varying degrees of correlation among balance, executive function and affective regulation, and as they related to the community reintegration success of patients with mTBI. The strongest, intermediate and weakest predictors for these patients’ success with community reintegration represented those for affective regulation, executive function, and dynamic balance and gait performance, respectively.
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Affiliation(s)
- Azadeh Leland
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center. Washington, DC, USA
| | - Kamran Tavakol
- University of Maryland Baltimore, School of Medicine Department of PTRS, Baltimore, MD, USA
| | - Joel Scholten
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center. Washington, DC, USA
| | - Alex V Libin
- Georgetown University, Rehabilitation Medicine, Well-being Literacy Program, Washington, DC, USA
| | - Debra Mathis
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center. Washington, DC, USA
| | - David Maron
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center. Washington, DC, USA
| | - Simin Bakhshi
- Department of Anesthesiology, Iran University, Tehran, Iran
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MacGregor AJ, Clouser MC, Mayo JA, Galarneau MR. Gender Differences in Posttraumatic Stress Disorder Among U.S. Navy Healthcare Personnel. J Womens Health (Larchmt) 2017; 26:338-344. [PMID: 28410014 DOI: 10.1089/jwh.2014.5130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The role of women in the U.S. military has changed markedly over the course of 20th- and 21st-century conflicts. Although women frequently occupy healthcare positions in the military, little is known about gender differences in posttraumatic stress disorder (PTSD) within this occupational subgroup. MATERIALS AND METHODS A total of 4275 (667 women and 3608 men) U.S. Navy healthcare personnel supporting military operations in Iraq and Afghanistan were identified from electronic deployment records. Data from Post-Deployment Health Assessments were abstracted to identify PTSD screen positives, and to adjust for self-reported combat exposure and other deployment experiences. RESULTS The prevalence of PTSD screen positive in the sample was 8.2% (n = 351/4275). After adjusting for combat exposure, previous psychiatric history, and demographics, women had significantly higher odds of screening positive for PTSD than did men (odds ratio = 1.99, 95% confidence interval 1.34-2.96). Interactions between gender and combat exposure, and between gender and previous psychiatric history were not statistically significant. CONCLUSIONS This is one of the first studies to examine gender differences in PTSD among military healthcare personnel. Future research should account for additional stressors, such as long work hours, disrupted sleep patterns, and number of casualties treated. As women are further integrated into military occupations that may lead to different exposures, knowledge of gender differences in the manifestation of PTSD is paramount for prevention and treatment purposes.
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Affiliation(s)
- Andrew J MacGregor
- Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center , San Diego, California
| | - Mary C Clouser
- Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center , San Diego, California
| | - Jonathan A Mayo
- Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center , San Diego, California
| | - Michael R Galarneau
- Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center , San Diego, California
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Libin AV, Scholten J, Schladen MM, Danford E, Shara N, Penk W, Grafman J, Resnik L, Bruner D, Cichon S, Philmon M, Tsai B, Blackman M, Dromerick A. Executive functioning in TBI from rehabilitation to social reintegration: COMPASS (goal,) a randomized controlled trial (grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013-2016). Mil Med Res 2015; 2:32. [PMID: 26664736 PMCID: PMC4675019 DOI: 10.1186/s40779-015-0061-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/30/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function. METHODS/DESIGN The COMPASS(goal) (Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community re-integration psychosocial research in veterans with mild traumatic brain injury. COMPASS(goal) integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASS(goal) will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management (intervention) and supported discharge (control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up. DISCUSSION Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.
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Affiliation(s)
- Alexander V. Libin
- />Mental Health Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422 USA
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
- />MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782 USA
| | - Joel Scholten
- />Physical Medicine and Rehabilitation Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422 USA
| | - Manon Maitland Schladen
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
- />MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782 USA
| | - Ellen Danford
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
| | - Nawar Shara
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
- />MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782 USA
| | - Walter Penk
- />Texas A&M College of Medicine, 8447 TX-47, Bryan, TX 77807 USA
| | - Jordan Grafman
- />Rehabilitation Institute of Chicago, 345 E Superior St., Chicago, IL 60611 USA
| | - Linda Resnik
- />Research Service, Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02908 USA
| | - Dwan Bruner
- />Physical Medicine and Rehabilitation Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, DC 20422 USA
| | - Samantha Cichon
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
| | - Miriam Philmon
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
| | - Brenda Tsai
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
| | - Marc Blackman
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
| | - Alexander Dromerick
- />MedStar National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010 USA
- />Research Service, Washington DC VA Medical Center, 50 Irving Street, NW, Washington, 20422 DC USA
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Woodcock T, Morganti-Kossmann MC. The role of markers of inflammation in traumatic brain injury. Front Neurol 2013; 4:18. [PMID: 23459929 PMCID: PMC3586682 DOI: 10.3389/fneur.2013.00018] [Citation(s) in RCA: 499] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/10/2013] [Indexed: 12/18/2022] Open
Abstract
Within minutes of a traumatic impact, a robust inflammatory response is elicited in the injured brain. The complexity of this post-traumatic squeal involves a cellular component, comprising the activation of resident glial cells, microglia, and astrocytes, and the infiltration of blood leukocytes. The second component regards the secretion immune mediators, which can be divided into the following sub-groups: the archetypal pro-inflammatory cytokines (Interleukin-1, Tumor Necrosis Factor, Interleukin-6), the anti-inflammatory cytokines (IL-4, Interleukin-10, and TGF-beta), and the chemotactic cytokines or chemokines, which specifically drive the accumulation of parenchymal and peripheral immune cells in the injured brain region. Such mechanisms have been demonstrated in animal models, mostly in rodents, as well as in human brain. Whilst the humoral immune response is particularly pronounced in the acute phase following Traumatic brain injury (TBI), the activation of glial cells seems to be a rather prolonged effect lasting for several months. The complex interaction of cytokines and cell types installs a network of events, which subsequently intersect with adjacent pathological cascades including oxidative stress, excitotoxicity, or reparative events including angiogenesis, scarring, and neurogenesis. It is well accepted that neuroinflammation is responsible of beneficial and detrimental effects, contributing to secondary brain damage but also facilitating neurorepair. Although such mediators are clear markers of immune activation, to what extent cytokines can be defined as diagnostic factors reflecting brain injury or as predictors of long term outcome needs to be further substantiated. In clinical studies some groups reported a proportional cytokine production in either the cerebrospinal fluid or intraparenchymal tissue with initial brain damage, mortality, or poor outcome scores. However, the validity of cytokines as biomarkers is not broadly accepted. This review article will discuss the evidence from both clinical and laboratory studies exploring the validity of immune markers as a correlate to classification and outcome following TBI.
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Affiliation(s)
- Thomas Woodcock
- Australian School of Advanced Medicine, Macquarie University Sydney, NSW, Australia
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Woodcock T, Morganti-Kossmann MC. The role of markers of inflammation in traumatic brain injury. Front Neurol 2013; 4:18. [PMID: 23459929 DOI: 10.3389/fneur.2013.00018.ecollection2013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 02/10/2013] [Indexed: 05/19/2023] Open
Abstract
Within minutes of a traumatic impact, a robust inflammatory response is elicited in the injured brain. The complexity of this post-traumatic squeal involves a cellular component, comprising the activation of resident glial cells, microglia, and astrocytes, and the infiltration of blood leukocytes. The second component regards the secretion immune mediators, which can be divided into the following sub-groups: the archetypal pro-inflammatory cytokines (Interleukin-1, Tumor Necrosis Factor, Interleukin-6), the anti-inflammatory cytokines (IL-4, Interleukin-10, and TGF-beta), and the chemotactic cytokines or chemokines, which specifically drive the accumulation of parenchymal and peripheral immune cells in the injured brain region. Such mechanisms have been demonstrated in animal models, mostly in rodents, as well as in human brain. Whilst the humoral immune response is particularly pronounced in the acute phase following Traumatic brain injury (TBI), the activation of glial cells seems to be a rather prolonged effect lasting for several months. The complex interaction of cytokines and cell types installs a network of events, which subsequently intersect with adjacent pathological cascades including oxidative stress, excitotoxicity, or reparative events including angiogenesis, scarring, and neurogenesis. It is well accepted that neuroinflammation is responsible of beneficial and detrimental effects, contributing to secondary brain damage but also facilitating neurorepair. Although such mediators are clear markers of immune activation, to what extent cytokines can be defined as diagnostic factors reflecting brain injury or as predictors of long term outcome needs to be further substantiated. In clinical studies some groups reported a proportional cytokine production in either the cerebrospinal fluid or intraparenchymal tissue with initial brain damage, mortality, or poor outcome scores. However, the validity of cytokines as biomarkers is not broadly accepted. This review article will discuss the evidence from both clinical and laboratory studies exploring the validity of immune markers as a correlate to classification and outcome following TBI.
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Affiliation(s)
- Thomas Woodcock
- Australian School of Advanced Medicine, Macquarie University Sydney, NSW, Australia
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Gordon SN, Fitzpatrick PJ, Hilsabeck RC. No effect of PTSD and other psychiatric disorders on cognitive functioning in veterans with mild TBI. Clin Neuropsychol 2011; 25:337-47. [PMID: 21360415 DOI: 10.1080/13854046.2010.550634] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There has been speculation that post-traumatic stress disorder (PTSD) superimposed on mild traumatic brain injury (mTBI) may have synergistic, negative effects on cognitive functioning. The purpose of this study was to investigate differences in processing speed, executive functioning, and memory of 82 veterans with mTBI and PTSD, mTBI, and another psychiatric condition, or mTBI alone. It was hypothesized that there would be no group differences in cognitive performances. Participants completed the Trail Making Test, Stroop, Rey Complex Figure, and California Verbal Learning Test-2. There were no significant group differences on any cognitive measure. Findings suggest that PTSD and other psychiatric disorders do not necessarily have a negative exacerbating effect on processing speed, executive functioning, or memory in veterans with mTBI.
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