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Zuniga RDDR, Vieira RDCA, Solla DJF, Godoy DA, Kolias A, de Amorim RLO, de Andrade AF, Teixeira MJ, Paiva WS. Long-term outcome of traumatic brain injury patients with initial GCS of 3-5. World Neurosurg X 2024; 23:100361. [PMID: 38511161 PMCID: PMC10950742 DOI: 10.1016/j.wnsx.2024.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
| | | | - Davi Jorge Fontoura Solla
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | | | | | - Robson Luis Oliveira de Amorim
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
- Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Almir Ferreira de Andrade
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
| | - Wellingson Silva Paiva
- Department of Neurology, Clinics Hospital of the University of São Paulo Medical School, São Paulo, São Paulo, Brazil
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Walsh MJ, Dodd MD, Cwiek AP, Hux K, Chiou KS. Metacognitive accuracy predicts self-reported quality of life following traumatic brain injury. Brain Inj 2024; 38:361-367. [PMID: 38329033 DOI: 10.1080/02699052.2024.2311336] [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: 05/09/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Metacognition and quality of life (QoL) are both adversely affected by traumatic brain injury (TBI), but the relation between them is not fully understood. As such, the purpose of this study was to determine the degree to which metacognitive accuracy predicts QoL in individuals with TBI. METHODS Eighteen participants with moderate-to-severe TBI completed a stimulus-response task requiring the discrimination of emotions depicted in pictures of faces and then provided a retrospective confidence judgment after each response. Metacognitive accuracy was calculated using participants' response accuracy and confidence judgment accuracy. Participants also completed the Quality of Life After Brain Injury (QOLIBRI) questionnaire to assess QoL in various areas of functioning. RESULTS Performance of a linear regression analysis revealed that higher metacognitive accuracy significantly predicted lower overall QoL. Additionally, higher metacognitive accuracy significantly predicted lower QoL related to cognition and physical limitations. CONCLUSION The study results provide evidence of an inverse relation between metacognitive performance and QoL following TBI. Metacognitive changes associated with TBI and their relation to QoL have several clinical implications for TBI rehabilitation.
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Affiliation(s)
- Michael J Walsh
- Department of Psychology and Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Michael D Dodd
- Department of Psychology and Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Andrew P Cwiek
- Department of Psychology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Karen Hux
- Quality Living Inc ., Omaha, Nebraska, USA
| | - Kathy S Chiou
- Department of Psychology and Center for Brain, Biology and Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Ponsford JL, Carty M, Olver J, Ponsford M, Acher R, McKenzie D, Downing MG. TEMPORARY REMOVAL: "It's Not Only the Injury but Also the Kind of Head." Factors Influencing Outcome After Traumatic Brain Injury. Arch Phys Med Rehabil 2024:S0003-9993(24)00884-0. [PMID: 38493908 DOI: 10.1016/j.apmr.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Jennie L Ponsford
- Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne; School of Psychological Sciences, Monash University, Melbourne, Australia; Epworth HealthCare, Melbourne
| | - Meagan Carty
- Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne; Epworth HealthCare, Melbourne
| | - John Olver
- Epworth HealthCare, Melbourne; Faculty of Medicine, Monash University, Melbourne
| | | | | | - Dean McKenzie
- Epworth HealthCare, Melbourne; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marina G Downing
- Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne; School of Psychological Sciences, Monash University, Melbourne, Australia
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Halalmeh DR, Salama HZ, LeUnes E, Feitosa D, Ansari Y, Sachwani-Daswani GR, Moisi MD. The Role of Neuropsychology in Traumatic Brain Injury: Comprehensive Literature Review. World Neurosurg 2024; 183:128-143. [PMID: 38104936 DOI: 10.1016/j.wneu.2023.12.069] [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: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
Traumatic brain injury (TBI) is a major public health concern, often leading to significant behavioral and cognitive changes with subsequent impairment in daily functioning and personal interactions. The management of TBI involves a multidisciplinary approach. Neuropsychology has emerged as a critical discipline in assessing, diagnosing, treating, and rehabilitating individuals with TBI. Successful management also requires careful consideration of the patient's cognitive status. Therefore, clinicians must have a comprehensive understanding of the overall clinical picture of the patient at the cognitive and physical level. The primary aim of this research is to explore the role of neuropsychology in TBI management and rehabilitation thoroughly while providing an updated review of the literature. Various neuropsychological assessment tools used to evaluate cognitive functioning in individuals with TBI will be discussed in addition to their validity, reliability, and usefulness in identifying cognitive deficits and developing individualized treatment plans. The findings in this article will have significant implications on the clinical practice of neuropsychology in TBI patients, highlighting the importance of neuropsychological assessment in optimizing the management of this population. The need for increased awareness of neuropsychology among health care professionals, especially in the acute hospital setting, is growing along with the increase in diagnosis of TBI and its complications. Adequate understanding of the complex interplay between cognitive, emotional, and behavioral factors in TBI can inform the development of new interventions and treatment strategies, making it equally as important for patients and their families.
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Affiliation(s)
- Dia R Halalmeh
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA; Department of Surgery, Michigan State University-College of Human Medicine, Traverse City, Michigan, USA; Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, Michigan, USA.
| | | | - Emma LeUnes
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
| | - David Feitosa
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA
| | - Yusuf Ansari
- Temple University, Philadelphia, Pennsylvania, USA
| | - Gul R Sachwani-Daswani
- Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, Michigan, USA
| | - Marc D Moisi
- Department of Neurosurgery, Hurley Medical Center, Flint, Michigan, USA; Department of Surgery, Michigan State University-College of Human Medicine, Traverse City, Michigan, USA; Department of Trauma and Acute Care Surgery, Hurley Medical Center, Flint, Michigan, USA
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5
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Simpson GK, McRae P, Gates TM, Daher M, Johnston D, Cameron ID. A vocational intervention that enhances return to work after severe acquired brain injury: A pragmatic trial. Ann Phys Rehabil Med 2023; 66:101787. [PMID: 37890426 DOI: 10.1016/j.rehab.2023.101787] [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: 11/03/2022] [Revised: 04/12/2023] [Accepted: 04/23/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Following a severe acquired brain injury, individuals often have low return to work rates. The Vocational Intervention Program (VIP), a partnership of Brain Injury Rehabilitation Program community rehabilitation centres with external vocational rehabilitation providers in New South Wales, Australia, was developed to facilitate a return to competitive employment for working-age people. OBJECTIVES To evaluate the efficacy of the VIP partnership model, this intervention was compared to outcomes from a health-based brain injury vocational rehabilitation centre (H-VR) or community brain injury rehabilitation centres ("treatment as usual"; TAU). METHODS A 3-arm non-randomized controlled trial was conducted among the 12 adult rehabilitation centres of the NSW Brain Injury Rehabilitation Program. The VIP arm was delivered by 6 community rehabilitation centres in partnership with 3 external private Vocational Rehabilitation providers. The H-VR arm was delivered by 1 health-based vocational rehabilitation centre and the 5 remaining centres delivered TAU. Competitive employment status ("Yes"/"No") and clinician ratings of disability and participation were collected pre- and post-intervention, and at 3-month follow-up. Multilevel models were conducted to investigate change over time by treatment arm. RESULTS In total, 148 individuals with severe brain injury were included in the trial: n = 75 (VIP), n = 33 (H-VR) and n = 40 (TAU). Sixty-five people (of 108, 60%) completed the VR intervention. A significant arm-by-time interaction was found, with higher return to work rates from pre- to post-intervention in VIP and H-VR arms compared to TAU (P = 0.0002). Significant arm-by-time interactions also indicated improved work-related participation and independent living skills from pre- to post-intervention in VIP and H-VR compared to the TAU arm (P < 0.05). These improvements were maintained at 3-month follow-up. CONCLUSIONS The VIP improved return to competitive employment at comparable rates to the specialist H-VR. Larger-scale adoption of the VIP model could provide significant improvements in vocational rehabilition sevices to support people in their return to work following severe brain injury. ANZCTR TRIAL REGISTRY NUMBER ACTRN12622000769785.
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Affiliation(s)
- Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia.
| | - Philippa McRae
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney, NSW, Australia
| | - Thomas M Gates
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Maysaa Daher
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, NSW Health, Sydney, NSW, Australia
| | - Deborah Johnston
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Ian D Cameron
- Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, NSW, Australia
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6
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Ikin Anderson M, Gopinath B, Fiona Jones K, Morey P, Simpson GK. Testing the stability of a family resilience model at 2 and 5 years after traumatic brain injury or spinal cord injury: A longitudinal study. Ann Phys Rehabil Med 2023; 66:101734. [PMID: 37030248 DOI: 10.1016/j.rehab.2023.101734] [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: 12/14/2021] [Revised: 10/06/2022] [Accepted: 12/10/2022] [Indexed: 04/10/2023]
Abstract
BACKGROUND Recent studies have tested models of resilience and caregiver adjustment in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). Few studies have examined the role of adaptive variables over time. OBJECTIVE Conduct a longitudinal study to test a model of caregiver resilience with caregiver outcomes at 2- and 5-years post-injury. METHOD Caregivers of relatives with TBI or SCI were surveyed at 2 years (Time 1) and 5 years (Time 2) post-injury. Stability of the resilience model across the 2 time-points was tested using structural equation modeling with multi-group analysis. Measures included resilience related variables (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Social Support Survey) and outcome variables (Caregiver Burden Scale, General Health Questionnaire-28, Medical Outcome Study Short Form -36 [SF-36] and Positive and Negative Affect Scale). RESULTS In total, 100 caregivers were surveyed at both 2 and 5 years (TBI =77, SCI =23). Scores for resilience (Time 1, 75.9 SD 10.6; Time 2, 71.5 SD 12.6) and self-efficacy (Time 1, 32.51 SD 3.85; Time 2, 31.66 SD 4.28) showed significant minor declines, with other variables remaining stable. The resilience model for the pooled responses (Time 1+ Time 2) demonstrated a good fit (Goodness of Fit Index [GFI] = 0.971; Incremental Fit Index [IFI] = 0.986; Tucker-Lewis Index [TLI] = 0.971; Comparative Fit Index [CFI] = 0.985 and Root Mean Square Error of Approximation [RMSEA] = 0.051). Multi-group analysis then compared Time 1 to Time 2 responses and found that a variant (compared to invariant) model best fitted the data, with social support having stronger associations with mental health and positive affect at Time 2 than Time 1. Hope reduced from Time 1 to Time 2. CONCLUSIONS The model suggests that resilience-related variables can play an important role in positive caregiver adjustment over time.
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Affiliation(s)
| | - Bamini Gopinath
- Macquarie University Hearing, Macquarie University, North Ryde, NSW, Australia
| | - Kate Fiona Jones
- Institute for Ethics and Society, The University of Notre Dame, Sydney, NSW Australia; Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Peter Morey
- School of Nursing and Health, Avondale University, Sydney, NSW, Australia
| | - Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney, NSW, Australia
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7
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Torregrossa W, Torrisi M, De Luca R, Casella C, Rifici C, Bonanno M, Calabrò RS. Neuropsychological Assessment in Patients with Traumatic Brain Injury: A Comprehensive Review with Clinical Recommendations. Biomedicines 2023; 11:1991. [PMID: 37509630 PMCID: PMC10376996 DOI: 10.3390/biomedicines11071991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Traumatic brain injury is damage to the brain occurring after birth, often resulting in the deterioration of cognitive, behavioural, and emotional functions. Neuropsychological evaluation can assist clinicians to better assess the patient's clinical condition, reach differential diagnoses, and develop interventional strategies. However, considering the multiple rating scales available, it is not easy to establish which tool is most suitable for the different brain injury conditions. The aim of this review is to investigate and describe the most used neurocognitive assessment tools in patients with traumatic brain injury to provide clinicians with clear indications on their use in clinical practice. Indeed, during the acute phase, after the head trauma, alertness and wakefulness of the patients affected by a disorder of consciousness can be assessed using different scales, such as the Coma Recovery Scale-Revised. In both postacute and chronic phases after traumatic brain injury, general cognitive assessment tools (such as the Mini Mental State Examination) or more specific cognitive tests (e.g., Wisconsin Card Sorting Test and Trail Making Test) could be administered according to the patient's functional status. In this way, clinicians may be aware of the patient's neuropsychological and cognitive level, so they can guarantee a personalized and tailored rehabilitation approach in this frail patient population.
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Affiliation(s)
- William Torregrossa
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Michele Torrisi
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Carmela Casella
- Department of Clinical and Experimental Medicine "AOU Policlinico G. Martino", University Hospital "G. Martino", 98124 Messina, Italy
| | - Carmela Rifici
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi "Bonino Pulejo", Via Palermo Cda Casazza, SS113, 98124 Messina, Italy
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8
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Strazzer S, Pastore V, Frigerio S, Colombo K, Galbiati S, Locatelli F, Galbiati S. Long-Term Vocational Outcome at 15 Years from Severe Traumatic and Non-Traumatic Brain Injury in Pediatric Age. Brain Sci 2023; 13:1000. [PMID: 37508935 PMCID: PMC10376968 DOI: 10.3390/brainsci13071000] [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: 06/14/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Recent studies suggest that acquired brain injury with impaired consciousness in infancy is related to more severe and persistent effects and may have a cumulative effect on ongoing development. In this work, we aim to describe vocational outcome in a group of patients at 15 years from a severe brain lesion they suffered in developmental age. METHODS This study included a total of 147 patients aged 1.5 to 14 years with acquired brain lesion. Clinical and functional details ("Glasgow Outcome Scale", "Functional Independent Measure" and Intelligence Quotient) were collected at the time of their first hospitalization and vocational outcome was determined after 15 years. RESULTS 94 patients (63.9%) presented with traumatic brain injury, while 53 patients (36.1%) presented with a brain lesion of other origin. Traumatic patients had a higher probability of being partly or fully productive than non-traumatic ones: 75.5% of traumatic subjects were working-taking into account limitations due to the traumatic event-versus 62.3% of non-traumatic ones. A relationship between some clinical variables and the vocational outcome was found. CONCLUSIONS Rehabilitation should adequately emphasize "vocational rehabilitation" because a significant proportion of people experiencing a disorder of consciousness in childhood may show good social integration in adult age.
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Affiliation(s)
- Sandra Strazzer
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, 22040 Bosisio Parini, Italy
| | - Valentina Pastore
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, 22040 Bosisio Parini, Italy
| | - Susanna Frigerio
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, 22040 Bosisio Parini, Italy
| | - Katia Colombo
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, 22040 Bosisio Parini, Italy
| | - Sara Galbiati
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, 22040 Bosisio Parini, Italy
| | - Federica Locatelli
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, 22040 Bosisio Parini, Italy
| | - Susanna Galbiati
- Acquired Brain Injury Unit, Scientific Institute IRCCS E. Medea, 22040 Bosisio Parini, Italy
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Corrigan F, Wee IC, Collins-Praino LE. Chronic motor performance following different traumatic brain injury severity-A systematic review. Front Neurol 2023; 14:1180353. [PMID: 37288069 PMCID: PMC10243142 DOI: 10.3389/fneur.2023.1180353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/05/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) is now known to be a chronic disease, causing ongoing neurodegeneration and linked to increased risk of neurodegenerative motor diseases, such as Parkinson's disease and amyotrophic lateral sclerosis. While the presentation of motor deficits acutely following traumatic brain injury is well-documented, however, less is known about how these evolve in the long-term post-injury, or how the initial severity of injury affects these outcomes. The purpose of this review, therefore, was to examine objective assessment of chronic motor impairment across the spectrum of TBI in both preclinical and clinical models. Methods PubMed, Embase, Scopus, and PsycINFO databases were searched with a search strategy containing key search terms for TBI and motor function. Original research articles reporting chronic motor outcomes with a clearly defined TBI severity (mild, repeated mild, moderate, moderate-severe, and severe) in an adult population were included. Results A total of 97 studies met the inclusion criteria, incorporating 62 preclinical and 35 clinical studies. Motor domains examined included neuroscore, gait, fine-motor, balance, and locomotion for preclinical studies and neuroscore, fine-motor, posture, and gait for clinical studies. There was little consensus among the articles presented, with extensive differences both in assessment methodology of the tests and parameters reported. In general, an effect of severity was seen, with more severe injury leading to persistent motor deficits, although subtle fine motor deficits were also seen clinically following repeated injury. Only six clinical studies investigated motor outcomes beyond 10 years post-injury and two preclinical studies to 18-24 months post-injury, and, as such, the interaction between a previous TBI and aging on motor performance is yet to be comprehensively examined. Conclusion Further research is required to establish standardized motor assessment procedures to fully characterize chronic motor impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols. Longitudinal studies investigating the same cohort over time are also a key for understanding the interaction between TBI and aging. This is particularly critical, given the risk of neurodegenerative motor disease development following TBI.
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Affiliation(s)
- Frances Corrigan
- Head Injury Lab, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Ing Chee Wee
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Lyndsey E. Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
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Borgen IMH, Løvstad M, Hauger SL, Forslund MV, Kleffelgård I, Andelic N, Sveen U, Søberg HL, Sigurdardottir S, Winter L, Lindstad MØ, Brunborg C, Røe C. Effect of an Individually Tailored and Home-Based Intervention in the Chronic Phase of Traumatic Brain Injury: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2310821. [PMID: 37145600 PMCID: PMC10163390 DOI: 10.1001/jamanetworkopen.2023.10821] [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: 12/19/2022] [Accepted: 03/14/2023] [Indexed: 05/06/2023] Open
Abstract
Importance Traumatic brain injury (TBI) can cause long-lasting and heterogeneous difficulties that require an individually tailored approach to rehabilitation. However, high-quality studies of treatment options in the chronic phase of TBI are lacking. Objective To evaluate the effect of a home-based, individualized, and goal-oriented rehabilitation intervention in the chronic phase of TBI. Design, Setting, and Participants This study was an intention-to-treat parallel-group assessor-blinded randomized clinical trial with 1:1 randomization to an intervention or control group. Participants included adults in southeastern Norway who had sustained a TBI more than 2 years earlier, lived at home, and had ongoing TBI-related difficulties. A population-based sample of 555 individuals were invited, and 120 were included. Participants were assessed at baseline, 4 months, and 12 months after inclusion. Specialized rehabilitation therapists provided the intervention in patients' homes or via video conference and telephone. Data collection was conducted between June 5, 2018, and December 14, 2021. Interventions The intervention group received an 8-session individually tailored and goal-oriented rehabilitation program over 4 months. The control group received usual care in their municipality. Main Outcomes and Measures Preestablished primary outcomes were disease-specific health-related quality of life (HRQOL; measured by the Quality of Life After Brain Injury [QOLIBRI] overall scale) and social participation (measured by the Participation Assessment With Recombined Tools-Objective [PART-O] social subscale). Preestablished secondary outcomes included generic HRQOL (measured by the EuroQol 5-dimension 5-level [EQ-5D-5L] questionnaire), difficulty with TBI-related problem management (target outcomes; mean severity calculated across 3 main self-identified problem areas that were individually measured using a 4-point Likert scale), TBI symptoms (measured by the Rivermead Post Concussion Symptoms Questionnaire [RPQ]), psychological distress (depression and anxiety; measured by the Patient Health Questionnaire 9-item scale and the Generalized Anxiety Disorder 7-item scale [GAD-7], respectively), and functional competency (measured by the Patient Competency Rating Scale). Results Among 120 participants in the chronic phase of TBI, the median (IQR) age was 47.5 (31.0-55.8) years, and the median (IQR) time since injury was 4 (3-6) years; 85 (70.8%) were male. A total of 60 participants were randomized to the intervention group, and 60 were randomized to the control group. Between baseline and 12 months, no significant between-group effects were found for the primary outcomes of disease-specific HRQOL (QOLIBRI overall scale score: 2.82; 97.5% CI, -3.23 to 8.88; P = .30) or social participation (PART-O social subscale score: 0.12; 97.5% CI, -0.14 to 0.38; P = .29). At 12 months, the intervention group (n = 57) had significantly higher generic HRQOL (EQ-5D-5L score: 0.05; 95% CI, 0.002-0.10; P = .04) and fewer symptoms of TBI (RPQ total score: -3.54; 95% CI, -6.94 to -0.14; P = .04) and anxiety (GAD-7 score: -1.39; 95% CI, -2.60 to -0.19; P = .02) compared with the control group (n = 55). At 4 months only, the intervention group (n = 59) had significantly less difficulty managing TBI-related problems (target outcomes mean severity score: -0.46, 95% CI, -0.76 to -0.15; P = .003) compared with the control group (n = 59). No adverse events were reported. Conclusions and Relevance In this study, no significant results were observed for the primary outcomes of disease-specific HRQOL or social participation. However, the intervention group reported improvements in secondary outcomes (generic HRQOL and symptoms of TBI and anxiety) that were maintained at 12-month follow-up. These findings suggest that rehabilitation interventions could help patients even in the chronic phase of TBI. Trial Registration ClinicalTrials.gov Identifier: NCT03545594.
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Affiliation(s)
- Ida M. H. Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marianne Løvstad
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Solveig L. Hauger
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Marit V. Forslund
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Ingerid Kleffelgård
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Center for Habilitation and Rehabilitation Models and Services, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department for Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Helene L. Søberg
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Laraine Winter
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania
| | - Marte Ørud Lindstad
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Update on the Efficacy of Cognitive Rehabilitation After Moderate to Severe Traumatic Brain Injury: A Scoping Review. Arch Phys Med Rehabil 2023; 104:315-330. [PMID: 35921874 DOI: 10.1016/j.apmr.2022.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify, categorize, and analyze the methodological issues of cognitive rehabilitation of patients with moderate to severe traumatic brain injury and its efficacy. DATA SOURCES Pubmed and PsycINFO were searched for studies published between 2015 and 2021 using keywords for cognitive intervention and traumatic brain injury. STUDY SELECTION Two independent reviewers selected articles concerning cognitive rehabilitation for adults with traumatic brain injury. Of 458 studies, 97 full-text articles were assessed and 46 met the inclusion criteria. DATA EXTRACTION Data were analyzed by 1 reviewer according to criteria concerning the methodological quality of studies. DATA SYNTHESIS Results showed a large scope of 7 cognitive domains targeted by interventions, delivered mostly in individual sessions (83%) with an integrative cognitive approach (48%). Neuroimaging tools as a measure of outcome remained scarce, featuring in only 20% of studies. Forty-three studies reported significant effects of cognitive rehabilitation, among which 7 fulfilled a high methodological level of evidence. CONCLUSIONS Advances and shortcomings in cognitive rehabilitation have both been highlighted and led us to develop methodological key points for future studies. The choice of outcome measures, the selection of control interventions, and the use of combined rehabilitation should be investigated in further studies.
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Lennon MJ, Brooker H, Creese B, Thayanandan T, Rigney G, Aarsland D, Hampshire A, Ballard C, Corbett A, Raymont V. Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study. J Neurotrauma 2023. [PMID: 36716779 DOI: 10.1089/neu.2022.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. We examined a subset (n = 15,764) of the PROTECT study, a cohort assessing risk factors for cognitive decline (ages between 50 and 90 years). Participants completed cognitive assessments annually for 4 years. Cognitive tests were grouped using a principal components analysis (PCA) into working memory, episodic memory, attention, processing speed, and executive function. Lifetime TBI severity and number were retrospectively recalled by participants using the Brain Injury Screening Questionnaire (BISQ). Linear mixed models (LMMs) examined the effect of severity of head injury (non-TBI head strike, mTBI, and moderate-severe TBI) and number of mTBI at baseline and over time. mTBI was considered as a continuous and categorical variable (groups: 0 mTBI, 1 mTBI, 2 mTBIs, 3 mTBIs, and 4+ mTBIs). Of the participants 5725 (36.3%) reported at least one mTBI and 510 (3.2%) at least one moderate-severe TBI, whereas 3711 (23.5%) had suffered at worst a non-TBI head strike and 5818 (32.9%) reported no head injuries. The participants had suffered their last reported head injury an average (standard deviation, SD) of 29.6 (20.0) years prior to the study. Regarding outcomes, there was no worsening in longitudinal cognitive trajectories over the study duration but at baseline there were significant cognitive deficits associated with TBI. At baseline, compared with those without head injury, individuals reporting at least one moderate-severe TBI had significantly poorer attention (B = -0.163, p < 0.001), executive scores (B = -0.151, p = 0.004), and processing speed (B = -0.075, p = 0.033). Those who had suffered at least a single mTBI also demonstrated significantly poorer attention scores at baseline compared with the no head injury group (B = -0.052, p = 0.001). Compared with those with no mTBI, those in the 3 mTBI group manifested poorer baseline executive function (B = -0.149, p = 0.025) and attention scores (B = -0.085, p = 0.015). At baseline, those who had suffered four or more mTBIs demonstrated poorer attention (B = -0.135, p < 0.001), processing speed (B = -0.072, p = 0.009), and working memory (B = -0.052, p = 0.036), compared with those reporting no mTBI. TBI is associated with fixed, dose, and severity-dependent cognitive deficits. The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities.
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Affiliation(s)
- Matthew J Lennon
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Tony Thayanandan
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Grant Rigney
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Dag Aarsland
- Department of Old Age Psychiatry, IoPPN, Kings College London, London, United Kingdom.,Centre for Age-Related Research, Stavanger University Hospital, Stavanger, Norway
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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13
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INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory. J Head Trauma Rehabil 2023; 38:83-102. [PMID: 36594861 DOI: 10.1097/htr.0000000000000837] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Memory impairments affecting encoding, acquisition, and retrieval of information after moderate-to-severe traumatic brain injury (TBI) have debilitating and enduring functional consequences. The interventional research reviewed primarily focused on mild to severe memory impairments in episodic and prospective memory. As memory is a common focus of cognitive rehabilitation, clinicians should understand and use the latest evidence. Therefore, the INCOG ("International Cognitive") 2014 clinical practice guidelines were updated. METHODS An expert panel of clinicians/researchers reviewed evidence published since 2014 and developed updated recommendations for intervention for memory impairments post-TBI, a decision-making algorithm, and an audit tool for review of clinical practice. RESULTS The interventional research approaches for episodic and prospective memory from 2014 are synthesized into 8 recommendations (6 updated and 2 new). Six recommendations are based on level A evidence and 2 on level B. In summary, they include the efficacy of choosing individual or multiple internal compensatory strategies, which can be delivered in a structured or individualized program. Of the external compensatory strategies, which should be the primary strategy for severe memory impairment, electronic reminder systems such as smartphone technology are preferred, with technological advances increasing their viability over traditional systems. Furthermore, microprompting personal digital assistant technology is recommended to cue completion of complex tasks. Memory strategies should be taught using instruction that considers the individual's functional and contextual needs while constraining errors. Memory rehabilitation programs can be delivered in an individualized or mixed format using group instruction. Computer cognitive training should be conducted with therapist guidance. Limited evidence exists to suggest that acetylcholinesterase inhibitors improve memory, so trials should include measures to assess impact. The use of transcranial direct current stimulation (tDCS) is not recommended for memory rehabilitation. CONCLUSION These recommendations for memory rehabilitation post-TBI reflect the current evidence and highlight the limitations of group instruction with heterogeneous populations of TBI. Further research is needed on the role of medications and tDCS to enhance memory.
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Salim A, Stein DM, Zarzaur BL, Livingston DH. Measuring long-term outcomes after injury: current issues and future directions. Trauma Surg Acute Care Open 2023; 8:e001068. [PMID: 36919026 PMCID: PMC10008475 DOI: 10.1136/tsaco-2022-001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/16/2023] [Indexed: 03/12/2023] Open
Abstract
Maximizing long-term outcomes for patients following injury is the next challenge in the delivery of patient-centered trauma care. The following review outlines three important components in trauma outcomes: (1) data gathering and monitoring, (2) the impact of traumatic brain injury, and (3) trajectories in recovery and identifies knowledge gaps and areas for needed future research.
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Affiliation(s)
- Ali Salim
- Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah M Stein
- Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ben L Zarzaur
- Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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15
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Rodríguez-Rajo P, García-Rudolph A, Sánchez-Carrión R, Aparicio-López C, Enseñat-Cantallops A, García-Molina A. Social and nonsocial cognition: Are they linked? A study on patients with moderate-to-severe traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:1039-1048. [PMID: 33174449 DOI: 10.1080/23279095.2020.1845171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The first aim was to study the relationship between Social Cognition (SC) and nonsocial Cognition (n-SC) measures in a group of patients with moderate or severe traumatic brain injury (TBI) to assess the dependence or independence of both types of cognition. The second aim was to explore the relationships between SC measures and generate a model based on the results of these relationships. METHODS AND PROCEDURES Forty-three subacute patients with TBI were included in the study. They were administered a SC battery and n-SC battery. SC battery included the following measures: International Affective Picture System (IAPS); Facial Expressions of Emotion-Stimuli Test (FEEST); Moving Shapes Paradigm (MSP); Reading the Mind in the Eyes Test- Revised Version (RMET); Social Decision Making Task (SDMT). n-SC battery included Digit Span Forwards and Backwards; Trail Making Test (Part A); Rey's Auditory Verbal Learning Test; Letter-Number Sequencing; and verbal fluency test (PMR). RESULTS FEEST, MSP and RMET were related to n-SC measures. The exploratory factor analysis shows a two-factor SC structure: Factor 1: Emotional recognition and mentalization (FEEST, MSP and RMET) and Factor 2: Acquisition and contextualization (IAPS and SDMT). CONCLUSION The performance of subjects with moderate-to-severe TBI in the SC measures is related, at least partially, by the performance in the n-SC measures. Our SC model shows a two-factor structure characterized by a first factor that brings together SC measures that are highly related to n-SC domains and a second factor that brings together measures whose performance is not influenced by n-SC domains.
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Affiliation(s)
- P Rodríguez-Rajo
- Institut Guttmann, Institut Universitari de Neurorehabilitació affiliated to the UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - A García-Rudolph
- Institut Guttmann, Institut Universitari de Neurorehabilitació affiliated to the UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - R Sánchez-Carrión
- Institut Guttmann, Institut Universitari de Neurorehabilitació affiliated to the UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - C Aparicio-López
- Institut Guttmann, Institut Universitari de Neurorehabilitació affiliated to the UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - A Enseñat-Cantallops
- Institut Guttmann, Institut Universitari de Neurorehabilitació affiliated to the UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - A García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació affiliated to the UAB, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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Mamman R, Mortenson WB, Fleming J, Schmidt J. Living in a reshaped reality: Exploring social participation and self-identity after TBI. Neuropsychol Rehabil 2022; 32:2102-2124. [PMID: 35997174 DOI: 10.1080/09602011.2022.2113100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Individuals with a moderate to severe traumatic brain injury (TBI) experience substantial changes in their life. This constructivist grounded theory study aimed to develop an explanatory model that explores the impact of changes in social participation and self-identity after sustaining a TBI. Sixteen participants with moderate to severe TBI (mean age = 49.8, 69% male) were recruited, and were on average 16.4 years post-injury (SD = 10.4). Data from semi-structured interviews were analysed thematically. An overarching theme of "living in a reshaped reality" was identified, which depicted how changes in social participation and self-identity influenced ongoing experiences with TBI. Three main themes were generated: (1) "there's nothing that's the same" highlighted the daily challenges individuals faced post-injury, (2) "rebuilding and restarting" described how individuals with TBI navigated through their unfamiliar reality, and (3) "embrace it and run with it" explored participants' reactions towards life with a TBI. An explanatory model was developed, consisting of the overarching theme ("living in a reshaped reality") with the three integrated themes. Future research and clinical practices can build on this understanding to develop programmes to help individuals address their needs in post-injury life.
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Affiliation(s)
- Rinni Mamman
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada
| | - W Ben Mortenson
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver General Hospital, Vancouver, Canada
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Julia Schmidt
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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17
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Pinard S, Bottari C, Laliberté C, Pigot H, Olivares M, Couture M, Aboujaoudé A, Giroux S, Bier N. Development of an Assistive Technology for Cognition to Support Meal Preparation in Severe Traumatic Brain Injury: User-Centered Design Study. JMIR Hum Factors 2022; 9:e34821. [PMID: 35925663 PMCID: PMC9389386 DOI: 10.2196/34821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/29/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although assistive technology for cognition (ATC) has enormous potential to help individuals who have sustained a severe traumatic brain injury (TBI) prepare meals safely, no ATC has yet been developed to assist in this activity for this specific population. Objective This study aims to conduct a needs analysis as a first step in the design of an ATC to support safe and independent meal preparation for persons with severe TBI. This included identifying cooking-related risks to depict future users’ profiles and establishing the clinical requirements of the ATC. Methods In a user-centered design study, the needs of 3 future users were evaluated in their real-world environments (supported-living residence) using an ecological assessment of everyday activities, a review of their medical files, a complete neuropsychological test battery, individual interviews, observational field notes, and log journals with the residents, their families, and other stakeholders from the residence (eg, staff and health professionals). The needs analysis was guided by the Disability Creation Process framework. Results The results showed that many issues had to be considered for the development of the ATC for the 3 residents and other eventual users, including cognitive issues such as distractibility and difficulty remembering information over a short period of time and important safety issues, such as potential food poisoning and risk of fire. This led to the identification of 2 main clinical requirements for the ATC: providing cognitive support based on evidence-based cognitive rehabilitation to facilitate meal preparation and ensuring safety at each step of the meal preparation task. Conclusions This needs analysis identified the main requirements for an ATC designed to support meal preparation for persons with severe TBI. Future research will focus on implementing the ATC in the residence and evaluating its usability.
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Affiliation(s)
- Stéphanie Pinard
- École de réadaptation, Université de Montréal, Montréal, QC, Canada.,Centre de réadaptation Estrie, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Carolina Bottari
- École de réadaptation, Université de Montréal, Montréal, QC, Canada.,Centre de recherche interdisciplinaire en réadaptation du Montréal Métropolitain, Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île de Montréal, Montréal, QC, Canada
| | - Catherine Laliberté
- DOMUS Laboratory, Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Hélène Pigot
- DOMUS Laboratory, Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche sur le vieillissement, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Marisnel Olivares
- DOMUS Laboratory, Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Mélanie Couture
- Centre for Research and Expertise in Social Gerontology, CIUSSS West-Central-of-Montreal, Côte Saint-Luc, QC, Canada.,Department of Psychology, Université de Sherbooke, Sherbrooke, QC, Canada
| | - Aline Aboujaoudé
- École de réadaptation, Université de Montréal, Montréal, QC, Canada.,Research Center, Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île de Montréal, Montréal, QC, Canada
| | - Sylvain Giroux
- DOMUS Laboratory, Department of Computer Science, Université de Sherbrooke, Sherbrooke, QC, Canada.,Centre de recherche sur le vieillissement, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Nathalie Bier
- École de réadaptation, Université de Montréal, Montréal, QC, Canada.,Research Center, Institut universitaire de gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Île de Montréal, Montréal, QC, Canada
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18
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Svingos AM, Robicsek SA, Hayes RL, Wang KK, Robertson CS, Brophy GM, Papa L, Gabrielli A, Hannay HJ, Bauer RM, Heaton SC. Predicting Clinical Outcomes 7-10 Years after Severe Traumatic Brain Injury: Exploring the Prognostic Utility of the IMPACT Lab Model and Cerebrospinal Fluid UCH-L1 and MAP-2. Neurocrit Care 2022; 37:172-183. [PMID: 35229233 DOI: 10.1007/s12028-022-01461-y] [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: 09/16/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is a major contributor to disability and mortality in the industrialized world. Outcomes of severe TBI are profoundly heterogeneous, complicating outcome prognostication. Several prognostic models have been validated for acute prediction of 6-month global outcomes following TBI (e.g., morbidity/mortality). In this preliminary observational prognostic study, we assess the utility of the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) Lab model in predicting longer term global and cognitive outcomes (7-10 years post injury) and the extent to which cerebrospinal fluid (CSF) biomarkers enhance outcome prediction. METHODS Very long-term global outcome was assessed in a total of 59 participants (41 of whom did not survive their injuries) using the Glasgow Outcome Scale-Extended and Disability Rating Scale. More detailed outcome information regarding cognitive functioning in daily life was collected from 18 participants surviving to 7-10 years post injury using the Cognitive Subscale of the Functional Independence Measure. A subset (n = 10) of these participants also completed performance-based cognitive testing (Digit Span Test) by telephone. The IMPACT lab model was applied to determine its prognostic value in relation to very long-term outcomes as well as the additive effects of acute CSF ubiquitin C-terminal hydrolase-L1 (UCH-L1) and microtubule associated protein 2 (MAP-2) concentrations. RESULTS The IMPACT lab model discriminated favorable versus unfavorable 7- to 10-year outcome with an area under the receiver operating characteristic curve of 0.80. Higher IMPACT lab model risk scores predicted greater extent of very long-term morbidity (β = 0.488 p = 0.000) as well as reduced cognitive independence (β = - 0.515, p = 0.034). Acute elevations in UCH-L1 levels were also predictive of lesser independence in cognitive activities in daily life at very long-term follow-up (β = 0.286, p = 0.048). Addition of two CSF biomarkers significantly improved prediction of very long-term neuropsychological performance among survivors, with the overall model (including IMPACT lab score, UCH-L1, and MAP-2) explaining 89.6% of variance in cognitive performance 7-10 years post injury (p = 0.008). Higher acute UCH-L1 concentrations were predictive of poorer cognitive performance (β = - 0.496, p = 0.029), whereas higher acute MAP-2 concentrations demonstrated a strong cognitive protective effect (β = 0.679, p = 0.010). CONCLUSIONS Although preliminary, results suggest that existing prognostic models, including models with incorporation of CSF markers, may be applied to predict outcome of severe TBI years after injury. Continued research is needed examining early predictors of longer-term outcomes following TBI to identify potential targets for clinical trials that could impact long-ranging functional and cognitive outcomes.
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Affiliation(s)
- Adrian M Svingos
- Brain Injury Clinical Research Center, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven A Robicsek
- Departments of Anesthesiology, Neurosurgery, and Neuroscience, University of Florida, Gainesville, FL, USA
| | | | - Kevin K Wang
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, FL, USA
| | | | - Gretchen M Brophy
- Pharmacotherapy and Outcomes Science and Neurosurgery, Virginia Commonwealth University Medical College of Virginia Campus, Richmond, VA, USA
| | - Linda Papa
- Department of Emergency Medicine, Orlando Health Orlando Regional Medical Center, Orlando, FL, USA
| | - Andrea Gabrielli
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA
| | - H Julia Hannay
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Russell M Bauer
- Brain Rehabilitation Research Center, Malcom Randall Department of Veterans Affairs Medical Center, Gainesville, FL, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shelley C Heaton
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
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19
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Denisova NP, Rzaev JA. Psychiatric mimics of neurosurgical disorders. PROGRESS IN BRAIN RESEARCH 2022; 272:153-171. [PMID: 35667800 DOI: 10.1016/bs.pbr.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Every year there are about 22.6 million people in need of neurosurgical care around the world, and one or several interventions are required to save lives and restore functional losses in more than half of these cases (13.8 million). Most neurosurgical interventions are performed in patients with traumatic brain and spinal cord injuries, strokes, central nervous system (CNS) tumors, hydrocephalus, and epilepsy. In addition to neurological symptoms, many CNS disorders are often accompanied by cognitive and/or behavioral changes. Physical and psychological symptoms can be intertwined as follows: 1) neurological symptoms may be manifested as a result of complex psychological processes; 2) psychological disorders may be manifested as neurological symptoms; 3) neurological disorders commonly cause secondary psychological responses; 4) psychological disorder may be induced more or less directly by an organic brain disease. In the present paper, we focus on the psychiatric conditions occurring in the patients with neurosurgical disorders who either get prepared for surgery or have already received it.
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Affiliation(s)
| | - Jamil A Rzaev
- Federal Neurosurgical Center, Novosibirsk, Russian Federation.
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20
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Rodríguez-Rajo P, García-Rudolph A, Sánchez-Carrión R, Aparicio-López C, Enseñat-Cantallops A, García-Molina A. Computerized social cognitive training in the subacute phase after traumatic brain injury: A quasi-randomized controlled trial. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-14. [PMID: 35196474 DOI: 10.1080/23279095.2022.2042693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To assess the usefulness of a computerized tasks module designed for the rehabilitation of social cognition (SC) in acquired brain injury. METHODS Quasi-randomized controlled trial (ClinicalTrials.gov:NCT03479970) involving 45 patients with moderate-severe traumatic brain injury (TBI) in a subacute inpatient rehabilitation hospital. The experimental group (n = 28) received treatment with a computerized SC module in combination with a non-SC module. The control group (n = 26) only received a treatment with non-SC module. RESULTS Intragroup comparisons showed that the experimental group had better results for all SC measures, except for International Affective Picture System (IAPS). The control group improved for Facial Expressions of cEmotion-Stimuli and Tests (FEEST) and Moving Shapes Paradigm (MSP), showing no changes with respect to pretreatment in IAPS, MSP and Reading the Mind in the Eyes Test (RMET). Intergroup comparisons did not present differences between the two groups for pretreatment measures. Post-treatment comparison showed that the experimental group obtained better results for RMET than the control group. CONCLUSION The computerized SC module was useful for the rehabilitation of SC in patients with moderate-severe TBI in the subacute phase. The group that received combined rehabilitative treatment (SC + non-SC) obtained better results for SC than the group that received treatment intended only for non-SC.
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Affiliation(s)
- P Rodríguez-Rajo
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A García-Rudolph
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - R Sánchez-Carrión
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - C Aparicio-López
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - A Enseñat-Cantallops
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - A García-Molina
- Institut Guttmann, Institut Universitari de Neurorehabilitació, Affiliated to the Universitat Autònoma de Barcelona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
- Facultad de Psicología, Centro de Estudios en Neurociencia Humana y Neuropsicología, Universidad Diego Portales, Santiago de Chile, Chile
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21
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Li G, Liu H, He Y, Hu Z, Gu Y, Li Y, Ye Y, Hu J. Neurological Symptoms and Their Associations With Inflammatory Biomarkers in the Chronic Phase Following Traumatic Brain Injuries. Front Psychiatry 2022; 13:895852. [PMID: 35815027 PMCID: PMC9263586 DOI: 10.3389/fpsyt.2022.895852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/31/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The underlying biological mechanisms for neurological symptoms following a traumatic brain injury (TBI) remain poorly understood. This study investigated the associations between serum inflammatory biomarkers and neurological symptoms in the chronic phase following moderate to severe TBI. METHODS The serum interleukin [IL]-1β, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, and the tumor necrosis factor [TNF]-α in 72 TBI patients 6 months to 2 years post injury were measured. Neurological symptoms including depression, chronic headache, sleep disturbance, irritability, anxiety, and global neurological disability was assessed. The associations between the biomarkers and the neurological symptoms were assessed using correlation and regression analysis. RESULTS It was found that the most common post-injury symptom was sleep disturbance (84.7%), followed by chronic headaches (59.7%), irritability (55.6%), and depression (54.2%). TNF-α was a protective factor for chronic headache (OR = 0.473, 95% CI = 0.235-0.952). IL-6 was positively associated with sleep disturbance (r = 0.274, p = 0.021), while IL-5 and IL-12p70 were negatively associated with the degree of global neurological disability (r = -0.325, p = 0.006; r = -0.319, p = 0.007). CONCLUSION This study provides preliminary evidence for the association between chronic inflammation with neurological symptoms following a TBI, which suggests that anti-inflammatory could be a potential target for post-TBI neurological rehabilitation. Further research with larger sample sizes and more related biomarkers are still needed, however, to elucidate the inflammatory mechanisms for this association.
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Affiliation(s)
- Gangqin Li
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Hao Liu
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yong He
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Zeqing Hu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yan Gu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yan Li
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yi Ye
- Department of Forensic Toxicological Analysis, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Junmei Hu
- Department of Forensic Psychiatry, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
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22
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Villalobos D, Bivona U. Post-traumatic Stress Disorder after Severe Traumatic Brain Injury: A Systematic Review. Arch Clin Neuropsychol 2021; 37:583-594. [PMID: 34933334 DOI: 10.1093/arclin/acab095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The review aimed to summarize the existing knowledge base regarding post-traumatic stress disorder after severe traumatic brain injury (TBI) and try to guide future research. METHOD Web of Science, Scopus, and PubMed databases were used to identify original studies that explored the relationship between severe TBI and post-traumatic stress disorder. RESULTS A total of 13 studies were included in the review. They have been examined in terms of potentially compatible and incompatible mechanisms, as well as of possible confounding factors in relation to the diagnosis of post-traumatic stress disorder after severe TBI. CONCLUSION Only a few studies in the literature have addressed the present topic; therefore, the prevalence of post-traumatic stress disorder in patients with severe TBI still needs to be further investigated. In particular, future studies should be conducted only in severe TBI populations, considering their premorbid personality characteristics and their reactivity alteration. They should also obtain an accurate and appropriate assessment of post-traumatic stress disorder with clinical interviews as well as clarifying the role of post-traumatic amnesia in this population by incorporating control groups of patients.
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Affiliation(s)
- Dolores Villalobos
- Department of Experimental Psychology, School of Psychology, Complutense University, Madrid, Spain.,Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology (Technical University of Madrid and Complutense University of Madrid), Madrid, Spain.,The European Centre of Neuroscience, Madrid, Spain
| | - Umberto Bivona
- IRCCS Fondazione Santa Lucia, Neuroriabilitazione 2, Rome, Italy
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23
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Blue-Enriched White Light Therapy Reduces Fatigue in Survivors of Severe Traumatic Brain Injury: A Randomized Controlled Trial. J Head Trauma Rehabil 2021; 35:E78-E85. [PMID: 31246878 DOI: 10.1097/htr.0000000000000500] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Fatigue is one of the disabling sequelae of traumatic brain injury (TBI), with repercussions on quality of life, rehabilitation, and professional reintegration. Research is needed on effective interventions. We evaluated efficacy of blue-enriched white light (BWL) therapy on fatigue of patients with severe TBI. SETTING Physical Medicine and Rehabilitation and Physiology departments of University hospitals. PARTICIPANTS Adult patients with fatigue symptoms following severe TBI, Fatigue Severity Scale (FSS) score 4 or more, Epworth Sleepiness Scale (ESS) score 10 or more, and/or Pittsburgh Sleep Quality Index (PSQI]) more than 5 were randomly assigned to one of 2 parallel groups: a BWL therapy group, with 30-minute exposure to waking white light enriched with blue for 4 weeks, and a group without light therapy (N-BWL), no light. DESIGN Randomized controlled trial. ClinicalTrials.gov number: NCT02420275. MAIN MEASURES The primary outcome measure was the response of the FSS to 4 weeks of treatment. In addition, we assessed latency change of the P300 component of event-related potentials before and after therapy. RESULTS Significant improvement in the FSS score (P = .026) was found in the BWL group compared with the N-BWL group. CONCLUSION BWL phototherapy reduces fatigue in patients with severe TBI.
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24
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Effect of a temporary lying position on cerebral hemodynamic and cerebral oxygenation parameters in patients with severe brain trauma. Acta Neurochir (Wien) 2021; 163:2595-2602. [PMID: 34236525 DOI: 10.1007/s00701-021-04851-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Temporary transition from the half-seated position (HSP) to the lying position (LyP) is often associated with an increase in intracranial pressure (ICP) during management of patients with severe traumatic brain injury (TBI). This study was designed to assess the impact of the temporary LyP on cerebral perfusion and oxygenation in cases of severe TBI. METHOD Patients with a severe blunt TBI with indication of ICP monitoring were prospectively included. Patients underwent standardized management according to the international guidelines to minimize secondary insults. For each patient, a maneuver to a LyP for 30 min was performed daily during the first 7 days of hospitalization. ICP, cerebral perfusion pressure (CPP), mean velocity (Vm), pulsatility index (PI), regional cerebral oxygen saturation (rScO2), jugular venous oxygen saturation (SvjO2)) were compared in the HSP and the LyP. RESULTS Twenty-four 24 patients were included. The median Glasgow coma scale score was 6 (interquartile range (IQR), 3-8), the median injury severity score was 32 (IQR, 25-48), and the mean age was 39 ± 16 years. On day 1, ICP (+ 6 mmHg (IQR, 4-7 mmHg)) and CPP (+ 10 mmHg (IQR, 5-14 mmHg) were significantly increased in the LyP compared with the HSP. Vm increased significantly in the LyP on the mainly injured side (+ 6 cm/s (IQR, + 0-11 cm/s); P = 0.01) and on the less injured side (+ 4 cm/s (IQR, + 1-8 cm/s); P < 0.01). rScO2 behaved similarly (+ 2 points (IQR, + 2-4 points) and + 3 points (IQR, + 2-5 points), respectively; P < 0.001). Mixed models highlighted the significant association between the position and CPP, Vm, rScO2, with more favorable conditions in the lying position. CONCLUSIONS Within the first week of management, the temporary LyP in cases of severe TBI was associated with a moderate increase in CPP, Vm, and rScO2despite a moderate increase in ICP.
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25
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De Freitas DJ, De Carvalho D, Paglioni VM, Brunoni AR, Valiengo L, Thome-Souza MS, Guirado VMP, Zaninotto AL, Paiva WS. Effects of transcranial direct current stimulation (tDCS) and concurrent cognitive training on episodic memory in patients with traumatic brain injury: a double-blind, randomised, placebo-controlled study. BMJ Open 2021; 11:e045285. [PMID: 34446480 PMCID: PMC8395342 DOI: 10.1136/bmjopen-2020-045285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 06/17/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Deficits in episodic memory following traumatic brain injury (TBI) are common and affect independence in activities of daily living. Transcranial direct current stimulation (tDCS) and concurrent cognitive training may contribute to improve episodic memory in patients with TBI. Although previous studies have shown the potential of tDCS to improve cognition, the benefits of the tDCS applied simultaneously to cognitive training in participants with neurological disorders are inconsistent. This study aims to (1) investigate whether active tDCS combined with computer-assisted cognitive training enhances episodic memory compared with sham tDCS; (2) compare the differences between active tDCS applied over the left dorsolateral prefrontal cortex (lDLPFC) and bilateral temporal cortex (BTC) on episodic memory and; (3) investigate inter and intragroup changes on cortical activity measured by quantitative electroencephalogram (qEEG). METHODS AND ANALYSIS A randomised, parallel-group, double-blind placebo-controlled study is conducted. Thirty-six participants with chronic, moderate and severe closed TBI are being recruited and randomised into three groups (1:1:1) based on the placement of tDCS sponges and electrode activation (active or sham). TDCS is applied for 10 consecutive days for 20 min, combined with a computer-based cognitive training. Cognitive scores and qEEG are collected at baseline, on the last day of the stimulation session, and 3 months after the last tDCS session. We hypothesise that (1) the active tDCS group will improve episodic memory scores compared with the sham group; (2) differences on episodic memory scores will be shown between active BTC and lDLPFC and; (3) there will be significant delta reduction and an increase in alpha waves close to the location of the active electrodes compared with the sham group. ETHICS AND DISSEMINATION This study was approved by Hospital das Clínicas, University of São Paulo Ethical Institutional Review Border (CAAE: 87954518.0.0000.0068). TRIAL REGISTRATION NUMBER NCT04540783.
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Affiliation(s)
- Daglie Jorge De Freitas
- Division of Neurology/Neurosurgery, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - Daniel De Carvalho
- Division of Neurology/Neurosurgery, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - Vanessa Maria Paglioni
- Division of Neurology/Neurosurgery, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - Andre R Brunoni
- Institute of Psychiatry, Hospital das Clinicas da Universidade de Sao Paulo, IPq HCFMUSP, University of São Paulo, São Paulo, Brazil
- Interdisciplinary Center for Applied Neuromodulation and Service of Interdisciplinary Neuromodulation, University of Sao Paulo, Sao Paulo, Brazil
| | - Leandro Valiengo
- Institute of Psychiatry, Hospital das Clinicas da Universidade de Sao Paulo, IPq HCFMUSP, University of São Paulo, São Paulo, Brazil
- Interdisciplinary Center for Applied Neuromodulation and Service of Interdisciplinary Neuromodulation, University of Sao Paulo, Sao Paulo, Brazil
| | - Maria Sigride Thome-Souza
- Institute of Psychiatry, Hospital das Clinicas da Universidade de Sao Paulo, IPq HCFMUSP, University of São Paulo, São Paulo, Brazil
| | - Vinícius M P Guirado
- Division of Neurology/Neurosurgery, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
| | - Ana Luiza Zaninotto
- Division of Neurology/Neurosurgery, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Wellingson S Paiva
- Division of Neurology/Neurosurgery, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo, HCFMUSP, Sao Paulo, Brazil
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26
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The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background and Purpose:
Psychosocial difficulties, including changed relationships are among the most pervasive and concerning issues following stroke. This study aimed to collate and thematically analyse qualitative literature describing the experience of close personal relationships from the perspective of stroke survivors.
Method:
Using a scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/Pubmed, Embase, Psychinfo) were systematically searched, yielding 3100 citations. Following exclusion of duplicates and screening against inclusion criteria at title/abstract and full text levels, 53 articles were included in the review. Data were charted and thematically analysed.
Results:
While research has increased since 2000, longitudinal designs are few. Four overarching themes and 12 subthemes were identified. ‘Social disruption’ described changing social worlds, lost social opportunities and shrinking networks. ‘Changed relationships’ included changed family and spousal relationships and changed parenting relationships. The third theme ‘relationships help’ highlighted positive aspects including belonging, support and a life worth living. The final theme was ‘coping with an altered social world’ and described adjustment and emotional responses.
Conclusions:
Relationships are an important aspect of life post stroke but are subject to changes and challenges. This article brings together a breadth of qualitative data to describe lived experiences. Further research, in particular, longitudinal research is required.
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Vallat-Azouvi C, Swaenepoël M, Ruet A, Bayen E, Ghout I, Nelson G, Pradat-Diehl P, Meaude L, Aegerter P, Charanton J, Jourdan C, Azouvi P. Relationships between neuropsychological impairments and functional outcome eight years after severe traumatic brain injury: Results from the PariS-TBI study. Brain Inj 2021; 35:1001-1010. [PMID: 34283665 DOI: 10.1080/02699052.2021.1933180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVES The objective was to assess the relationships between neuropsychological impairments, functional outcome and life satisfaction in a longitudinal study of patients after a severe traumatic brain injury (TBI) (PariS-TBI study). PATIENTS Out of 243 survivors, 86 were evaluated 8 years post-injury. They did not significantly differ from patients lost-to-follow up except for the latter being more frequently students or unemployed before the injury. METHODS Outcome measures included the Glasgow Outcome Scale-Extended (GOS-E), a functional independence questionnaire, employment, mood, fatigue and satisfaction with life. Neuropsychological outcome was assessed by two ways: performance-based outcome measures, using neuropsychological tests and patient and relative-based measures. RESULTS Neuropsychological measures were not significantly related to initial injury severity nor to gender, but were significantly related to age and education. After statistical correction for multiple comparisons, cognitive testing and cognitive questionnaires were significantly correlated with most outcome measures. By contrast, satisfaction with life was only related with patient-rated questionnaires. A regression analysis showed that the Trail-Making-Test-A was the best predictor of functional outcome, in addition to education duration. CONCLUSIONS Cognitive measures, particularly slowed information processing speed, were significant indicators of functional outcome at a long-term post-injury, beyond and above demographics or injury severity measures.
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Affiliation(s)
- Claire Vallat-Azouvi
- UR Fonctionnement et Dysfonctionnement Cognitifs : les âges de la vie (DYSCO), Université Paris 8-Saint-Denis, Saint-Denis, France.,Antenne UEROS- UGECAM IDF, Hôpital Raymond Poincaré, Garches, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Marie Swaenepoël
- Antenne UEROS- UGECAM IDF, Hôpital Raymond Poincaré, Garches, France
| | - Alexis Ruet
- Centre Hospitalier Universitaire De Caen, Service De Médecine Physique Et De Réadaptation, Caen, France
| | - Eleonore Bayen
- Assistance Publique-Hôpitaux De Paris, Groupe Hospitalier Pitié-Salpêtrière, Service De Médecine Physique Et Réadaptation, Paris, and Paris Sorbonne Université, Paris, France
| | - Idir Ghout
- Assistance Publique-Hôpitaux De Paris, Hôpital Ambroise Paré, Unité De Recherche Clinique (URC), Boulogne, France
| | - Gaelle Nelson
- Centre Ressources Francilien Du Traumatisme Crânien (CRFTC), Paris, France
| | - Pascale Pradat-Diehl
- Assistance Publique-Hôpitaux De Paris, Groupe Hospitalier Pitié-Salpêtrière, Service De Médecine Physique Et Réadaptation, Paris, and Paris Sorbonne Université, Paris, France
| | - Layide Meaude
- Assistance Publique-Hôpitaux De Paris, Hôpital Ambroise Paré, Unité De Recherche Clinique (URC), Boulogne, France
| | - Philippe Aegerter
- Assistance Publique-Hôpitaux De Paris, Hôpital Ambroise Paré, Unité De Recherche Clinique (URC), Boulogne, France
| | - James Charanton
- Centre Ressources Francilien Du Traumatisme Crânien (CRFTC), Paris, France
| | - Claire Jourdan
- Centre Hospitalier Universitaire De Montpellier, Service De Médecine Physique Et De Réadaptation, Montpellier, France
| | - Philippe Azouvi
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France.,Assistance Publique-Hôpitaux De Paris, Hôpital Raymond Poincaré, Service De Médecine Physique Et De Réadaptation, Garches, France
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Abstract
PURPOSE OF REVIEW Recovery after severe brain injury is variable and challenging to accurately predict at the individual patient level. This review highlights new developments in clinical prognostication with a special focus on the prediction of consciousness and increasing reliance on methods from data science. RECENT FINDINGS Recent research has leveraged serum biomarkers, quantitative electroencephalography, MRI, and physiological time-series to build models for recovery prediction. The analysis of high-resolution data and the integration of features from different modalities can be approached with efficient computational techniques. SUMMARY Advances in neurophysiology and neuroimaging, in combination with computational methods, represent a novel paradigm for prediction of consciousness and functional recovery after severe brain injury. Research is needed to produce reliable, patient-level predictions that could meaningfully impact clinical decision making.
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Szarka N, Szellar D, Kiss S, Farkas N, Szakacs Z, Czigler A, Ungvari Z, Hegyi P, Buki A, Toth P. Effect of Growth Hormone on Neuropsychological Outcomes and Quality of Life of Patients with Traumatic Brain Injury: A Systematic Review. J Neurotrauma 2021; 38:1467-1483. [PMID: 33677992 PMCID: PMC8672110 DOI: 10.1089/neu.2020.7265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
One of the most devastating chronic consequences of traumatic brain injury (TBI) is cognitive impairment. One of the possible underlying causes is growth hormone deficiency (GHD) caused by TBI-induced hypopituitarism. Currently, TBI patients are not routinely screened for pituitary function, and there are no standard therapies when GHD is diagnosed. Further, the possible positive effects of GH replacement on cognitive function and quality of life after TBI are not well established. We aimed to assess the current knowledge regarding the effect of GH therapy on cognitive function and quality of life after TBI. We performed a literature search in PubMed, Embase, and Central® databases from inception to October 2019. We extracted data on each term of severity (mild-moderate-severe) of TBI with and without GHD, time since injury, parameters of growth hormone treatment (dosing, length), and cognitive outcomes in terms of verbal and non-verbal memory, and executive, emotional, and motor functions, and performed a meta-analysis on the results of a digit span test assessing working memory. We identified 12 studies (containing two randomized controlled trials) with 264 mild-to-moderate-to-severe TBI patients (Glasgow Coma Score [GCS] varied between 6 and 15) with (n = 255) or without (n = 9) GHD who received GH therapy. GH was administered subcutaneously in gradually increasing doses, monitoring serum insulin-like growth factor-I (IGF-I) level. After TBI, regardless of GCS, 6-12 months of GH therapy, started in the chronic phase post-TBI, induced a moderate improvement in processing speed and memory capacities, decreased the severity of depression, and led to a marked improvement in quality of life. Limitations include the relatively low number of patients involved and the divergent neuropsychological tests used. These results indicate the need for further multi-centric controlled studies to substantiate the use of GH replacement therapy as a potential tool to alleviate TBI-related cognitive impairment and improve quality of life.
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Affiliation(s)
- Nikolett Szarka
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Dora Szellar
- Department of Pediatrics, University of Pecs Medical School, Pecs, Hungary
| | - Szabolcs Kiss
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Zsolt Szakacs
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Andras Czigler
- Department of Neurosurgery and Szentagothai Research Center, University of Pecs Medical School, Pecs, Hungary
| | - Zoltan Ungvari
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center on Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Peter Hegyi
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
| | - Andras Buki
- Department of Neurosurgery and Szentagothai Research Center, University of Pecs Medical School, Pecs, Hungary
| | - Peter Toth
- Institute for Translational Medicine, Medical School, University of Pecs, Pecs, Hungary
- Department of Neurosurgery and Szentagothai Research Center, University of Pecs Medical School, Pecs, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- MTA-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary
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30
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Trotta JK, Ekanayake V, Ettenhofer ML, Hungerford LD, Lange RT, Bailie JM, Brickell TA, Kennedy JE, French LM. Intracranial Abnormalities Are Associated With Fewer Self-Reported Symptoms in Military Service Members Following Moderate-to-Severe Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:164-174. [PMID: 33201040 DOI: 10.1097/htr.0000000000000637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examined the relationship between intracranial abnormalities (ICAs) and self-reported neurobehavioral and posttraumatic stress (PTS) symptoms in members of the military with moderate-to-severe traumatic brain injury (msTBI). METHOD Participants included 539 members of the US military with nonpenetrating msTBI. Self-reported neurobehavioral and PTS symptoms were assessed using the Neurobehavioral Symptom Inventory and the PTSD Checklist-Civilian Version. ICAs were categorized as present/absent (by subtype) based upon medical record review. Spearman rank-order correlations and stepwise multiple regression analyses examined univariate and combined predictive relationships between ICAs and self-reported symptoms. RESULTS The presence of any ICA was associated with reduced self-reported neurobehavioral and PTS symptoms. ICA-associated reductions were largest for PTS, followed by affective and cognitive neurobehavioral symptoms, and relatively weak for somatic/sensory and vestibular symptoms. Effects of different types of ICAs were comparable. Greater time since injury was related to greater symptom report, whereas duration of loss of consciousness and posttraumatic amnesia were not consistently related to self-reported symptoms. CONCLUSIONS Results suggest that ICAs are associated with suppression of reported PTS and neurobehavioral symptoms-potentially via reduction in self-awareness. These findings support comprehensive, objective evaluation to identify impairments in self-awareness and functioning in msTBI patients.
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Affiliation(s)
- Jenna K Trotta
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland (Mss Trotta and Ekanayake and Drs Ettenhofer, Hungerford, Lange, Bailie, Brickell, Kennedy, and French); Naval Medical Center San Diego, San Diego, California (Mss Trotta and Ekanayake and Drs Ettenhofer and Hungerford); General Dynamics Health Solutions, Falls Church, Virginia (Ms Trotta and Drs Ettenhofer, Hungerford, Lange, Bailie, Brickell, and Kennedy); American Hospital Services Group, Exton, Pennsylvania (Ms Ekanayake); Uniformed Services University of the Health Sciences, Bethesda, Maryland (Drs Ettenhofer, Brickell, and French); University of California, San Diego (Dr Ettenhofer); University of British Columbia, Vancouver, British Columbia, Canada (Dr Lange); National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland (Drs Lange, Brickell, and French); Naval Hospital Camp Pendleton, Camp Pendleton, California (Dr Bailie); and Brooke Army Medical Center, Fort Sam Houston, Texas (Dr Kennedy)
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31
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El-Khatib H, Sanchez E, Arbour C, Van Der Maren S, Duclos C, Blais H, Carrier J, Simonelli G, Hendryckx C, Paquet J, Gosselin N. Slow wave activity moderates the association between new learning and traumatic brain injury severity. Sleep 2021; 44:5992297. [PMID: 33211874 DOI: 10.1093/sleep/zsaa242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/16/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep-wake complaints and difficulties in making new learning are among the most persistent and challenging long-term sequelea following moderate to severe traumatic brain injury (TBI). Yet, it is unclear whether, and to what extent, sleep characteristics during the chronic stage of TBI contribute to sleep-wake and cognitive complaints. We aimed to characterize sleep architecture in chronic moderate to severe TBI adults and assess whether non-rapid eye movement slow wave activity (SWA) is associated to next day performance in episodic memory tasks according to TBI severity. METHODS Forty-two moderate to severe TBI participants, 12-47 months post-injury, and 38 healthy controls were tested with one night of in-laboratory polysomnography, followed the next morning by questionnaires (sleep quality, fatigue, and sleepiness) and neuropsychological assessment. We used multiple regression analyses to assess the moderator effect of SWA power on TBI severity and next-day memory performance. RESULTS We found that TBI participants reported worse sleep quality and fatigue, and had worse cognitive performance than controls. No between group differences were found on macro- and micro-architecture of sleep. However, SWA significantly interacted with TBI severity to explain next-day memory performance: higher SWA was more strongly associated to better memory performance in more severe TBI compared to milder TBI. CONCLUSIONS This study provides evidence that the injured brain is able to produce macro- and micro-architecture of sleep comparable to what is seen in healthy controls. However, with increasing TBI severity, lower non-rapid eye movement SWA power is associated with reduced ability to learn and memorise new information the following day.
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Affiliation(s)
- Héjar El-Khatib
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Erlan Sanchez
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Neurosciences, Université de Montréal, Montreal, Quebec, Canada
| | - Caroline Arbour
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Solenne Van Der Maren
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Catherine Duclos
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Hélène Blais
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Guido Simonelli
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Charlotte Hendryckx
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Jean Paquet
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre de Recherche du CIUSSS NIM, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
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Richard M, Lagares A, Bondanese V, de la Cruz J, Mejan O, Pavlov V, Payen JF. Study protocol for investigating the performance of an automated blood test measuring GFAP and UCH-L1 in a prospective observational cohort of patients with mild traumatic brain injury: European BRAINI study. BMJ Open 2021; 11:e043635. [PMID: 33632753 PMCID: PMC7908910 DOI: 10.1136/bmjopen-2020-043635] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) is a common cause of clinical consultation in the emergency department. Patients with mTBI may undergo brain CT scans based on clinical criteria. However, the proportion of patients with brain lesions on CT is very low. Two serum biomarkers, glial fibrillar acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), have been shown to discriminate patients regarding the presence or absence of brain lesions on initial CT scan when assessed within the first 12 hours after TBI. However, the current technique for measuring serum concentrations of GFAP and UCH-L1 is manual and time consuming, which may hinder its use in routine clinical practice. This study assesses the diagnostic accuracy of an automated assay for the measurement of serum GFAP and UCH-L1 in a cohort of patients with mTBI who received a CT scan as the standard of care. METHODS AND ANALYSIS This is a prospective multicentre observational study of 1760 patients with mTBI recruited in France and Spain across 16 participating sites. Adult patients with an initial Glasgow Coma Scale score of 13-15 and a brain CT scan underwent blood sampling within 12 hours after TBI. The primary outcome measure is the diagnostic performance of an automated assay measuring serum concentrations of GFAP and UCH-L1 for discriminating between patients with positive and negative findings on brain CT-scans. Secondary outcome measures include the performance of these two biomarkers in predicting the neurological status and quality of life at 1 week and 3 months after the trauma. ETHICS AND DISSEMINATION Ethics approval was obtained by the Institutional Review Board of Sud-Ouest Outre Mer III in France (Re#2019-A01525-52) and Hospital 12 de Octubre in Spain (Re#19/322). The results will be presented at scientific meetings and published in peer-reviewed publications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT04032509.
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Affiliation(s)
- Marion Richard
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Alfonso Lagares
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Instituto de Investigación imas12, Madrid, Spain
| | - Victor Bondanese
- bioMérieux, Clinical Unit, Chemin de l'Orme, Marcy l'Etoile, Spain
| | - Javier de la Cruz
- Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, SAMID, Madrid, France
| | - Odile Mejan
- bioMérieux, Clinical Unit, Chemin de l'Orme, Marcy l'Etoile, Spain
| | - Vladislav Pavlov
- bioMérieux, Medical Affairs, Chemin de l'Orme, Marcy-l'Étoile, France
| | - Jean-François Payen
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
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Debarle C, Perlbarg V, Jacquens A, Pélégrini-Issac M, Bisch M, Prigent A, Lesimple B, Caron E, Lefort M, Bayen E, Galanaud D, Pradat-Diehl P, Puybasset L, Degos V. Global mean diffusivity: A radiomarker discriminating good outcome long term after traumatic brain injury. Ann Phys Rehabil Med 2021; 64:101433. [PMID: 32992024 DOI: 10.1016/j.rehab.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 07/29/2020] [Accepted: 08/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a chronic pathology responsible for cognitive disorders impacting outcome. Global clinical outcome several years after TBI may be associated with anatomical sequelae. Anatomical lesions are not well described because characterizing diffuse axonal injury and brain atrophy require using specific MRI sequences with quantitative measures. The best radiologic parameter to describe the lesions long term after TBI is not known. OBJECTIVE We aimed to first, assess the global volumetric and diffusion parameters related to long-term outcome after TBI and second, define the most discriminating parameter. METHODS In this observational study, we included 96 patients with severe TBI and 22 healthy volunteers. The mean delay after TBI was 63.2 months [range 31-119]. The Glasgow Outcome Scale Extended (GOS-E) was used to assess the global long-term clinical outcome. All patients underwent multimodal MRI with measures of brain volume, ventricle volume, global fractional anisotropy (FA) and global mean diffusivity (MD). RESULTS All 96 participants had significant impairment in global FA, global MD, brain volume and ventricle volume as compared with the 22 controls (P<0.01). Only global MD significantly differed between the "good recovery" group (GOS-E score 7-8) and the other two groups: GOS-E scores 3-4 and 5-6. Brain volume significantly differed between the GOS-E 7-8 and 3-4 groups. Global MD was the most discriminating radiological parameter for the "good recovery" group versus other patients, long term after TBI. FA appeared less relevant at this time. Global atrophy was higher in patients than controls but lacked reliability to discriminate groups of patients. CONCLUSION Global mean diffusivity seems a more promising radiomarker than global FA for discriminating good outcome long term after TBI. Further work is needed to understand the evolution of these long-term radiological parameters after TBI.
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Affiliation(s)
- Clara Debarle
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif and Réadaptation (HaMCRe), Paris, France.
| | - Vincent Perlbarg
- BRAINTALE SAS, Paris, France; Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Alice Jacquens
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France; Sorbonne Université, Groupe de Recherche Clinique Biosfast, Paris, France
| | | | - Marion Bisch
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Amélie Prigent
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Blandine Lesimple
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Elsa Caron
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France
| | - Muriel Lefort
- Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Eléonore Bayen
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif and Réadaptation (HaMCRe), Paris, France
| | - Damien Galanaud
- Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France; AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neuroradiological Department, Paris, France
| | - Pascale Pradat-Diehl
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif and Réadaptation (HaMCRe), Paris, France; Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Louis Puybasset
- Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France; AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Vincent Degos
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France; Sorbonne Université, Groupe de Recherche Clinique Biosfast, Paris, France
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Ruet A, Bayen E, Jourdan C, Vallat-Azouvi C, Azerad S, Grimaldi L, Meaude L, Charanton J, Azouvi P. Potential for recovery between 4 and 8 years after a severe traumatic brain injury. Data from the PariS-TBI longitudinal study. Ann Phys Rehabil Med 2020; 64:101422. [PMID: 32763484 DOI: 10.1016/j.rehab.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/24/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Severe traumatic brain injury (TBI) is a leading cause of complex and persistent disability. Yet, long-term change in global functioning and determinants of this change remain unclear. OBJECTIVES This study aimed to assess change in global functioning in the long-term after severe TBI and factors associated with the change. METHODS This was a prospective observational study of an inception cohort of adults with severe TBI in the Paris area (PariS-TBI). Outcome was assessed at 1, 4 and 8 years post-injury. For the included participants (n=257), change in global outcome between 4 and 8 years was evaluated with the Glasgow Outcome Scale Extended (GOSE) score, and its association with pre-injury, injury-related and post-injury variables was tested with univariate and multivariable analyses. RESULTS More than half of the 73 participants evaluated at both 4 and 8 years showed global improvement (of at least one point) in GOSE score and an improvement in mood, executive function, and subjective complaints. On univariate analysis, none of the pre-injury, injury or post-injury variables were associated with GOSE score change between 4 and 8 years, except for GOSE score at 4 years (rho=-0.24, P=0.04). On multivariable analysis, probability of increased GOSE score was associated with more years of education (odds ratio 1.18 [95% confidence interval 1.02-1.37], P=0.03). The change in GOSE score was significantly correlated with change in Hospital Anxiety Depression Scale score between 4 and 8 years (rho=-0.42, P<0.001). CONCLUSIONS Most participants with severe TBI in the present sample showed a late improvement (4 to 8 years post-injury) in global functioning. Of the socio-demographic and injury-related factors, only more years of education was associated with improvement in global functioning. Decreased anxiety and depression symptoms were associated with improved global functioning. Targeting interventions to enhance resilience may be the most effective in the long-term after severe TBI.
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Affiliation(s)
| | - Eléonore Bayen
- Département de rééducation neurologique, faculté de médecine, hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Claire Jourdan
- Département de médecine physique et de réadaptation, CHU de Lapeyronie, Montpellier, France
| | - Claire Vallat-Azouvi
- Antenne UEROS-SAMSAH92-UGECAM IDF, hôpital Raymond-Poincaré, Garches, France; HANDIReSP, EA4047, université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France; EA 2027, laboratoire de psychopathologie et neuropsychologie, Paris, France
| | - Sylvie Azerad
- Unité de recherche clinique, hôpital Ambroise-Paré, AP-HP, Boulogne, France
| | - Lamiae Grimaldi
- Unité de recherche clinique, hôpital Ambroise-Paré, AP-HP, Boulogne, France; LA-SER and Pasteur Institute (Pharmacoepidemiology and Infectious Diseases Unit), Paris, France
| | - Layide Meaude
- Unité de recherche clinique, hôpital Ambroise-Paré, AP-HP, Boulogne, France
| | - James Charanton
- Centre ressources francilien du traumatisme crânien (CRFTC), Paris, France
| | - Philippe Azouvi
- HANDIReSP, EA4047, université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France; Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, AP-HP, Garches, France
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Lippa SM, French LM, Bell RS, Brickell TA, Lange RT. United States Military Service Members Demonstrate Substantial and Heterogeneous Long-Term Neuropsychological Dysfunction after Moderate, Severe, and Penetrating Traumatic Brain Injury. J Neurotrauma 2020; 37:608-617. [PMID: 31559904 DOI: 10.1089/neu.2019.6696] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of the study was to examine long-term neuropsychological outcome after moderate, severe, and penetrating traumatic brain injury (TBI) in U.S. military service members and veterans (SMVs). Eighty-five SMVs with a history of moderate (n = 18), severe (n = 17), or penetrating (n = 26) TBI, or an injury without TBI (i.e., trauma control [TC], n = 24) were assessed five or more years (mean = 69.4 months; standard deviation = 35.6) post-injury. All passed performance validity tests. Participants completed a battery of neurocognitive tests and a personality inventory. Five cognitive domain composites, each composed of four test scores, and an overall test battery mean (OTBM) were computed. The penetrating TBI group performed worse than the TC group and/or the moderate TBI group on most cognitive domains and the OTBM. The severe TBI group also performed worse than the TC group and moderate TBI group on processing speed and the OTBM, and worse than the TC group on attention/working memory. Just more than half of participants with severe (56%) or penetrating (64%) TBI met criteria for mild neurocognitive disorder, with processing speed the most commonly impaired domain. In addition, 80% of TBI participants had one or more clinically elevated scales on the Minnesota Multiphasic Personality Inventory-2-Restructured Form® (MMPI-2-RF), with somatic complaints the most common elevation. In conclusion, there was significantly reduced cognitive and psychological functioning many years after severe and penetrating TBI in SMVs. Cognitive and psychological dysfunction, however, were highly variable, with a substantial minority of SMVs having good outcome. Long-term individualized support is necessary for individuals after moderate, severe, and penetrating TBI.
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Affiliation(s)
- Sara M Lippa
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Randy S Bell
- Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Neurological Surgery Department, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland.,Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, Maryland.,National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland.,University of British Columbia, Vancouver, British Columbia, Canada
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Algethamy H. Baseline Predictors of Survival, Neurological Recovery, Cognitive Function, Neuropsychiatric Outcomes, and Return to Work in Patients after a Severe Traumatic Brain Injury: an Updated Review. Mater Sociomed 2020; 32:148-157. [PMID: 32843865 PMCID: PMC7428895 DOI: 10.5455/msm.2020.32.148-157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Severe traumatic brain injury (sTBI) is a common cause of death and disability worldwide, with long-term squeal among survivors that include cognitive deficits, psychosocial and neuropsychiatric dysfunction, failure to return to pre-injury levels of work, school and inter-personal relationships, and overall reduced quality of and satisfaction with life. Aim The aim of this work is to review the current literature on baseline predictors of outcomes in adults post sTBI. Method Most of available literature on baseline predictors of outcomes in adults post sTBI were reviewed and summarized in this work. Results Currently, a sizeable number of composite predictors of mortality and overall function exists; however, these instruments tend to over-estimate poor outcomes and fail to address issues like cognition, psychosocial/ neuropsychiatric dysfunction, and return to work or school. Conclusion This article reviews currently-identified predictors of all these outcomes.
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Affiliation(s)
- Haifa Algethamy
- Department of Anaesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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LaBuzetta JN, Rosand J, Vranceanu AM. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. Neurocrit Care 2019; 31:534-545. [PMID: 31486026 PMCID: PMC7007600 DOI: 10.1007/s12028-019-00826-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California-San Diego, 9444 Medical Center Drive, ECOB 3-028, MC 7740, La Jolla, CA, 92037, USA.
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ana-Maria Vranceanu
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Predicting mood outcome following traumatic brain injury (TBI): PTA & demographic variables. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground and aims:Mood disturbance is frequent after traumatic brain injury (TBI), often assessed using the Hospital Anxiety and Depression Scale (HADS). Research supports a three-factor HADS structure (anxiety, depression, and psychomotor), although this has not been used to investigate demographic variables and mood outcome post-TBI. This study examined severity of TBI, demographic variables [age, gender, estimated premorbid IQ (EIQ), relationship status, employment status, socio-economic status (SES)], and mood outcome, using HADS factor scores from a large adult population sample in Tasmania.Method:HADS factor scores were calculated for an initial sample of 596 adults. The sample sizes varied according to those attending at 1, 6, 12 and 24 months post-TBI and the available data for each dependent variable.Results:Significantly higher anxiety, depression, and psychomotor scores were reported at most follow-ups by females, the middle-aged, and those with lower IQs. Longer post-traumatic amnesia (PTA) was associated with significantly greater mood problems. Occasional significant findings at earlier follow-ups for the factors were noted for those unemployed. Other variables were rarely significant. PTA, premorbid IQ, and Age were included in most Multiple Regression equations predicting outcome for the factors, with Gender included for Anxiety and depression at 6 months after injury.Conclusions:Key demographic variables and PTA severity relate to mood post-TBI, and contribute to predicting mood outcome. Differences in findings for the three factors support their use in clinical practice.
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Svingos AM, Asken BM, Jaffee MS, Bauer RM, Heaton SC. Predicting long-term cognitive and neuropathological consequences of moderate to severe traumatic brain injury: Review and theoretical framework. J Clin Exp Neuropsychol 2019; 41:775-785. [DOI: 10.1080/13803395.2019.1620695] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Adrian M. Svingos
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Breton M. Asken
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S. Jaffee
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Russell M. Bauer
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shelley C. Heaton
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
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O'Neil J, van Ierssel J, Sveistrup H. Remote supervision of rehabilitation interventions for survivors of moderate or severe traumatic brain injury: A scoping review. J Telemed Telecare 2019; 26:520-535. [PMID: 31148489 DOI: 10.1177/1357633x19845466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Individuals with moderate or severe traumatic brain injury (TBI) often have persistent impairments upon discharge home. In rural communities, specialized rehabilitation services to address impairments can be difficult to access. The purpose of this scoping review is to examine how remote supervision is currently being used in TBI rehabilitation to identify gaps in knowledge that need to be addressed to facilitate access to and implementation of these services. METHODS The main objective for this review is to identify the methods being used to deliver remote supervision for rehabilitation in a moderate or severe TBI population. The aim of this review was to document the implementation characteristics of remote supervision used including: (1) type of supervision such as synchronous, asynchronous supervision or mixed; (2) frequency and intensity of remote supervision; and (3) outcomes used to measure intervention delivery as well as effectiveness within this population. This scoping review follows EQUATOR Network recommendations for screening and extracting data. RESULTS Twenty-six studies using a variety of remote supervision technology and outcome measures were included. Supervision frequency and intensity are poorly reported with no standardization. One hundred and six outcome measures were reported in this review showing large diversity in the areas being explored. DISCUSSION Different types of remote supervision have been used with this population; however, there are no clear guidelines on clinical implementation. Future studies must better define implementation parameters of remote supervision. Benefit on physical activity, balance and mobility outcomes also need to be further explored.
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Affiliation(s)
- Jennifer O'Neil
- School of Rehabilitation Sciences, University of Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada
| | | | - Heidi Sveistrup
- School of Rehabilitation Sciences, University of Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,School of Human Kinetics, University of Ottawa, Canada
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Flynn MA, Rigon A, Kornfield R, Mutlu B, Duff MC, Turkstra LS. Characterizing computer-mediated communication, friendship, and social participation in adults with traumatic brain injury. Brain Inj 2019; 33:1097-1104. [PMID: 31100990 PMCID: PMC6625844 DOI: 10.1080/02699052.2019.1616112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adults with traumatic brain injury (TBI) report loss of friendship and reduced social participation after injury, but there is limited information regarding quantity of friends and methods of communication. Our objective was to characterize friendship networks, social participation, and methods of communication, including computer-mediated communication (CMC), used by adults with TBI compared to uninjured adults. METHODS Participants were 25 adults with TBI and 26 uninjured healthy comparisons (HC) adults, who completed the Participation Assessment with Recombined Tools-Objective (PART-O) and the Social Network Questionnaire (SNQ). RESULTS Adults with TBI had significantly fewer total friends and significantly lower levels of productivity and overall social participation. Face-to-face interaction was the preferred method of contact for both groups. Adults with TBI were significantly less likely to use texting as a primary method of communication than their uninjured peers, but used other methods of communication at similar rates. CONCLUSION Our study supports prior findings of reduced friendships and reduced social participation after TBI and adds new information about similarities and differences in communication methods between adults with and without TBI.
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Affiliation(s)
- Margaret A. Flynn
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, USA
| | - Arianna Rigon
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
| | | | - Bilge Mutlu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, USA
| | - Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Lyn S. Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Chang HK, Hsu JW, Wu JC, Huang KL, Chang HC, Bai YM, Chen TJ, Chen MH. Risk of attempted suicide among adolescents and young adults with traumatic brain injury: A nationwide longitudinal study. J Affect Disord 2019; 250:21-25. [PMID: 30826490 DOI: 10.1016/j.jad.2019.02.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/15/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) and suicidal behavior lead to serious morbidity and premature mortality. TBI in adulthood is associated with a higher incidence of suicide, but the risk in adolescents and young adults is not clear. METHODS Longitudinal follow-up data were extracted from a National Health Insurance Research Database. Adolescents and young adults (12-29 years old) with and without TBI (1:4) were included, and the incidences of following attempted suicide were analyzed. The association of TBI severity, repeated TBI, and comorbid psychiatric disorders with attempted suicide were also investigated. RESULTS Overall, 31,599 and 126,396 subjects were enrolled in the TBI and control cohorts, respectively. The overall incidence of attempted suicide was significantly higher in the TBI cohort than in the control cohort (4.6% versus 1.0%, P < 0.001). The age at first suicide attempt was also lower in the TBI cohort (25.71 ± 5.25 versus 28.99 ± 5.26 years, P < 0.001). After adjusting for confounding factors, severe TBI, repeated TBI, female, younger age at TBI, and comorbid psychiatric conditions (unipolar depression, bipolar disorder, alcohol and substance use disorders) were associated with higher risks of attempted suicide. Long-term cumulative risks of attempted suicide were significantly elevated in the TBI cohort (P < 0.001). LIMITATION Access to individual's detailed medical record was not available. CONCLUSION TBI is associated with an elevated risk of attempted suicide in adolescents and young adults. TBI severity, repetitive injury, female, younger age at injury, and certain psychiatric comorbidities are independent risk factors.
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Affiliation(s)
- Hsuan-Kan Chang
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huang-Chou Chang
- Department of Surgery and School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Bayen E, Ruet A, Jourdan C, Ghout I, Meaude L, Pradat-Diehl P, Nelson G, Vallat-Azouvi C, Charanton J, Aegerter P, Azouvi P. Lawsuit and Traumatic Brain Injury: The Relationship Between Long-Lasting Sequelae and Financial Compensation in Litigants. Results From the PariS-TBI Study. Front Neurol 2019; 10:320. [PMID: 31031685 PMCID: PMC6473085 DOI: 10.3389/fneur.2019.00320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/14/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose: People with traumatic brain injury are frequently involved in a litigation because another person was at fault for causing the accident. A compensation amount will often be settled to compensate the victim for the past, present, future damages and losses suffered. We report descriptive data about the full and final personal compensation amount and investigated its association with patient's outcomes. Methods: We used a longitudinal prospective study of severe TBI patients injured in 2005–2007 (PariS-TBI). Questions regarding involvement in a litigation were asked concurrently with 4 and 8-year outcomes. Results: Among 160 participants assessed 4 and/or 8 years post-injury, a total of 67 persons declared being involved in a litigation, among which 38 people reported a compensation amount of a mean €292,653 (standard deviation = 436,334; interquartile 25–50–75 = 37,000–100,000–500,000; minimum = 1,500-maximum = 2,000,000). A higher compensation amount was associated with more severe disability and cognitive impairment in patients, and with more informal care time provided by caregivers. However, no significant association related to patient's gender, age, years of education, motor/balance impairment, return to work status, mood and related to caregiver's subjective burden was found. Conclusion: Financial compensation was related to victims' long-term severity of impairment, although some extreme cases with severe disability were granted very poor compensation.
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Affiliation(s)
- Eléonore Bayen
- Physical Medicine and Rehabilitation Department, Assistance Publique des Hôpitaux de Paris, Pitie-Salpetriere Hospital, Paris, France.,Physical and Rehabilitation Department, Sorbonne Université GRC18, Paris, France.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Alexis Ruet
- Physical Medicine and Rehabilitation Department, Caen Faculty Hospital, INSERM U1077, France
| | - Claire Jourdan
- Physical Medicine and Rehabilitation Department, Lapeyronie Faculty Hospital, Montpellier, France
| | - Idir Ghout
- Department of Biostatistics, Assistance Publique des Hôpitaux de Paris, Ambroise Paré Hospital, Boulogne, France
| | - Layide Meaude
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital (APHP), Paris, France
| | - Pascale Pradat-Diehl
- Physical Medicine and Rehabilitation Department, Assistance Publique des Hôpitaux de Paris, Pitie-Salpetriere Hospital, Paris, France.,Physical and Rehabilitation Department, Sorbonne Université GRC18, Paris, France.,Laboratoire d'Imagerie Biomedicale INSERM U1146, Paris, France
| | - Gaëlle Nelson
- Regional Reference Center for Brain Injury in the Parisian Area, Paris, France
| | - Claire Vallat-Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Physical Medicine and Rehabilitation Department, Assistance Publique des Hôpitaux de Paris, Raymond-Poincaré Faculty Hospital, Garches, France
| | - James Charanton
- Regional Reference Center for Brain Injury in the Parisian Area, Paris, France
| | - Philippe Aegerter
- Department of Biostatistics, Assistance Publique des Hôpitaux de Paris, Ambroise Paré Hospital, Boulogne, France
| | - Philippe Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Physical Medicine and Rehabilitation Department, Assistance Publique des Hôpitaux de Paris, Raymond-Poincaré Faculty Hospital, Garches, France
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Carlozzi NE, Hanks R, Lange RT, Brickell TA, Ianni PA, Miner JA, French LM, Kallen MA, Sander AM. Understanding Health-related Quality of Life in Caregivers of Civilians and Service Members/Veterans With Traumatic Brain Injury: Establishing the Reliability and Validity of PROMIS Mental Health Measures. Arch Phys Med Rehabil 2019; 100:S94-S101. [PMID: 29932885 PMCID: PMC6301134 DOI: 10.1016/j.apmr.2018.05.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/07/2018] [Accepted: 05/24/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide important reliability and validity data to support the use of the Patient-Reported Outcomes Measurement Information System (PROMIS) mental health measures in caregivers of civilians or service members/veterans (SMVs) with traumatic brain injury (TBI). DESIGN Patient-reported outcome surveys administered through an electronic data collection platform. SETTING Three TBI model systems rehabilitation hospitals, an academic medical center, and a military medical treatment facility. PARTICIPANTS Caregivers (N=560) of individuals with a documented TBI (344 civilians and 216 military). INTERVENTION Not applicable. MAIN OUTCOME MEASURES PROMIS anxiety, depression, and anger item banks. RESULTS Internal consistency for all the PROMIS Mental Health item banks was very good (all α>.86) and 3-week test-retest reliability was good to adequate (ranged from .65 to .85). Convergent validity and discriminant validity of the PROMIS measures were also supported. Caregivers of individuals who were low functioning had worse emotional health-related quality of life (HRQOL) (as measured by the 3 PROMIS measures) than caregivers of high-functioning individuals, supporting known groups validity. Finally, levels of distress, as measured by the PROMIS measures, were elevated for those caring for low-functioning individuals in both samples (rates ranged from 26.2% to 43.6% for caregivers of low-functioning individuals). CONCLUSIONS Results support the reliability and validity of the PROMIS anxiety, depression, and anger item banks in caregivers of civilians and SMVs with TBI. Ultimately, these measures can be used to provide a standardized assessment of HRQOL because it relates to mental health in these caregivers.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Robin Hanks
- Department of Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, MI; Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | - Rael T Lange
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; University of British Columbia, Vancouver, British Columbia, Canada
| | - Tracey A Brickell
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Phillip A Ianni
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Louis M French
- Defense and Veterans Brain Injury Center, Walter Reed National Military Medical Center, Bethesda, MD; National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine & Harris Health System, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
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Leśniak MM, Iwański S, Szutkowska-Hoser J, Seniów J. Comprehensive cognitive training improves attention and memory in patients with severe or moderate traumatic brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:570-579. [PMID: 30884968 DOI: 10.1080/23279095.2019.1576691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Traumatic brain injury (TBI) leads to cognitive disorders, the most frequently affected functions being attention and memory. The present study aimed to investigate the effects of a cognitive rehabilitation program, consisting of individual and group interventions, on attention and memory in patients with TBI. Fifteen patients-in the postacute phase of recovery from moderate-to-severe TBI and subsequent cognitive disorders-were enrolled on a three-week waiting list and then underwent a three-week cognitive rehabilitation program. The patients were assessed using a set of five neuropsychological attention and memory tests. The patients and their caregivers were questioned to assess subjective changes in the everyday functioning of the former. The introduction of cognitive training was associated with improvement in one memory test and in two measures of attention. Mean effect size across all tests was higher over the period with treatment compared to the period without (d = 0.36 vs. 0.03). Both patients and caregivers reported significant improvements in everyday functioning (p < .05). There were no further improvements at the four-month follow-up assessment. A comprehensive program of cognitive rehabilitation may improve attention and memory, as well as everyday cognitive functioning, in patients with severe or moderate TBI.
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Affiliation(s)
| | - Szczepan Iwański
- 2nd Department of Neurology, Institute of Psychiatry & Neurology, Warsaw, Poland
| | | | - Joanna Seniów
- 2nd Department of Neurology, Institute of Psychiatry & Neurology, Warsaw, Poland
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Ruet A, Bayen E, Jourdan C, Ghout I, Meaude L, Lalanne A, Pradat-Diehl P, Nelson G, Charanton J, Aegerter P, Vallat-Azouvi C, Azouvi P. A Detailed Overview of Long-Term Outcomes in Severe Traumatic Brain Injury Eight Years Post-injury. Front Neurol 2019; 10:120. [PMID: 30846966 PMCID: PMC6393327 DOI: 10.3389/fneur.2019.00120] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background and aims: Severe traumatic brain injury is a leading cause of acquired persistent disabilities, and represents an important health and economic burden. However, the determinants of long-term outcome have rarely been systematically studied in a prospective longitudinal study of a homogeneous group of patients suffering exclusively from severe TBI Methods: Prospective observational study of an inception cohort of adult patients with severe traumatic brain injury in the Parisian area (PariS-TBI). Outcome was assessed with face-to-face interview 8 years after Traumatic Brain Injury, focusing on impairments, activity limitations, and participation restriction. Results: Five hundred and four patients were included between 2005 and 2007. At 8-year follow-up, 261 patients were deceased, 128 were lost to follow-up, 22 refused to participate, and 86 were finally evaluated. Age, gender, initial injury severity did not significantly differ between evaluated patients and lost to follow-up, but the latter were more frequently students or unemployed. Mean age was 41.9 (SD 13.6), 79% were male, median initial Glasgow Coma Scale Score was 6. The most frequent somatic complaints concerned balance (47.5%), motricity (31%), and headaches (36%), but these were less frequent than cognitive complaints (Memory 71%, Slowness 68%, Concentration 67%). According to the Hospital Anxiety and Depression Scale (HADS), 25 % had a score >8 for anxiety and 23.7% for depression. According to the Extended Glasgow Outcome Scale, 19.8% remained severely disabled, 46.5% moderately disabled, 33.7% had a good recovery. Older age, longer education duration, lower functional status upon intensive care discharge, and more severe 8-year dysexecutive problems were significantly associated with a lower Extended Glasgow Outcome Scale score in multivariable analysis. At 8 years, 48.7% of patients were employed in a productive job. Of those, 38% declared a salary loss since traumatic brain injury. Unemployment was significantly associated with lower 1-year GOSE score and more severe 8-year dysexecutive problems. Conclusions: These results from an inception cohort study highlight the fact that long-term outcome after severe TBI is determined by a complex combination of injury-related, demographic and neuropsychological factors. Long after the injury, persisting impairments still interfere with social integration, and participation.
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Affiliation(s)
- Alexis Ruet
- Physical Medicine and Rehabilitation Department, CHRU, Caen, France.,Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,EPHE, INSERM, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Eléonore Bayen
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France.,Sorbonne Université GRC18, Paris, France
| | - Claire Jourdan
- Physical Medicine and Rehabilitation Department, Lapeyronie Hospital, CHRU, Montpellier, France
| | - Idir Ghout
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Layidé Meaude
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Astrid Lalanne
- Physical Medicine and Rehabilitation Department, APHP, Raymond-Poincaré Hospital, Garches, France
| | - Pascale Pradat-Diehl
- Physical Medicine and Rehabilitation Department, Pitie-Salpetriere Hospital, APHP, Paris, France.,Laboratoire d'Imagerie Biomedicale Inserm U1146, Sorbonne Université GRC18, Paris, France
| | - Gaëlle Nelson
- Regional Reference Center for Bain Injury in the Parisan Area, CRFTC, Paris, France
| | - James Charanton
- Regional Reference Center for Bain Injury in the Parisan Area, CRFTC, Paris, France
| | - Philippe Aegerter
- Unité de Recherche Clinique Paris Ile-de-France Ouest, Ambroise Paré Hospital, APHP, Boulogne, France
| | - Claire Vallat-Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Antenne UEROS-SAMSAH92-UGECAM IDF, Hôpital Raymond Poincaré, Garches, France.,Laboratoire de Psychopathologie et Neuropsychologie, EA 2027, Université Paris 8, Saint-Denis, France
| | - Philippe Azouvi
- Laboratoire de Recherches Cliniques et en Santé publique sur les Handicaps Psychiques, Cognitifs et Moteurs (HANDIReSP, EA4047), Université de Versailles Saint-Quentin, Montigny-Le-Bretonneux, France.,Physical Medicine and Rehabilitation Department, APHP, Raymond-Poincaré Hospital, Garches, France
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Douglas J. Loss of friendship following traumatic brain injury: A model grounded in the experience of adults with severe injury. Neuropsychol Rehabil 2019; 30:1277-1302. [PMID: 30755079 DOI: 10.1080/09602011.2019.1574589] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Relationships make important contributions to wellbeing and maintenance of self-worth. For those who sustain traumatic brain injury (TBI), life is frequently characterized by declining interpersonal relationships. The aim of this study was to understand the post-injury experience of friendship from the perspective of adults with severe TBI. Participants were 23 adults who had sustained severe TBI on average 10 years earlier; the majority was between 25 and 45 years old. The experience of friendship was explored using a convergent mixed methods design (quantitative self-report measures and in-depth interviews). Qualitative analysis of interview transcripts employed open and focussed coding to reveal themes and categories. Participants nominated on average 3.35 (SD 2.19) friends. When paid carers and family members were excluded, the mean dropped to 1.52 (SD 1.38). Exploratory correlations between number of friends and quality of life, depression and strong-tie support revealed significant associations of moderate to large effects. The post-injury experience of friendship was broadly conceptualized as "going downhill" with four overlapping phases: losing contact, being misunderstood, wanting to share and hanging on. Participants' stories illustrated how rehabilitation can focus on friendship by supporting established relationships and facilitating access to activities that afford interpersonal encounters and opportunities to share experiences.
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Affiliation(s)
- Jacinta Douglas
- Living with Disability Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.,Summer Foundation, Melbourne, Australia.,NHMRC Centre of Research Excellence in Traumatic Brain Injury Psychosocial Rehabilitation, Canberra, Australia
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Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) remains an unfortunately common disease with potentially devastating consequences for patients and their families. However, it is important to remember that it is a spectrum of disease and thus, a one 'treatment fits all' approach is not appropriate to achieve optimal outcomes. This review aims to inform readers about recent updates in prehospital and neurocritical care management of patients with TBI. RECENT FINDINGS Prehospital care teams which include a physician may reduce mortality. The commonly held value of SBP more than 90 in TBI is now being challenged. There is increasing evidence that patients do better if managed in specialized neurocritical care or trauma ICU. Repeating computed tomography brain 12 h after initial scan may be of benefit. Elderly patients with TBI appear not to want an operation if it might leave them cognitively impaired. SUMMARY Prehospital and neuro ICU management of TBI patients can significantly improve patient outcome. However, it is important to also consider whether these patients would actually want to be treated particularly in the elderly population.
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The Things that Help, the Things that Get in the Way: Working Together to Improve Outcome Following Acquired Brain Injury. BRAIN IMPAIR 2018. [DOI: 10.1017/brimp.2018.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Working in neurological rehabilitation brings with it numerous opportunities to gain an understanding of the factors that contribute to shaping meaningful living and wellbeing for those tackling the major life changes encountered following acquired brain injury (ABI). These opportunities come in many forms: challenging and brave clients, wise and worrying families, questioning and inspiring colleagues, empowering and limiting work environments and rigid and advancing policy and legislative contexts.Our personal and collective understanding ofthe things that helpandthe things that get in the wayof effective rehabilitation continuously emerges from the convergence of the experience and knowledge afforded by these opportunities. The aim of this paper is to considerthe things that helpandthe things that get in the wayas they have been identified by people with ABI, their families and those who work with them and have been further evidenced through research targeted towards improving short, medium and long-term outcomes for those living with the consequences of ABI. Thesethingsas discussed in this paper capture the essential role of the self, the importance of rights and access to rehabilitation, the impact of the family and the contribution of social connection.
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Abstract
Traumatic brain injury (TBI) is the cause for long-term disability in more than 3 million patients in the US alone, with chronic pain being the most frequently reported complain. To date, predisposing mechanisms for chronic pain in TBI patients are largely unknown. Psychological disorders, including post-traumatic stress disorder, depression and anxiety following TBI are commonly reported comorbidities to post-traumatic pain. Long term consequences can be debilitating and affect quality of life even when the injury is mild. In this review, we present the most commonly reported chronic pain conditions across the spectrum of severity of TBI, mainly focusing on mild TBI. We discuss chronic post- traumatic headaches, widespread pain as well as post-traumatic central pain. We discuss pain in the context of injury severity and military versus civilian populations. We are only starting to understand the biological mechanisms behind post-traumatic pain and associated psychological distress following TBI, with genetic, biochemical and imaging studies pointing to the dopaminergic, neurotrophic factors and the role of Apolipoprotein. Physiological and neurological mechanisms are proposed to partially explain this interaction between post-traumatic pain and psychological distress. Nevertheless, the evidence for the role of structural brain damage remains incomplete and to a large extent debatable, as it is still difficult to establish clear causality between brain trauma and chronic pain. Finally, general aspects of management of chronic pain post-TBI are addressed.
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