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Govier DJ, Gilbert TA, Jacob RL, Lafferty M, Mulcahy A, Pogoda TK, Zogas A, O’Neil ME, Pugh MJ, Carlson KF. Prevalence and Correlates of VA-Purchased Community Care Use Among Post-9/11-Era Veterans With Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:207-217. [PMID: 38709829 PMCID: PMC11074530 DOI: 10.1097/htr.0000000000000888] [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] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Post-9/11-era veterans with traumatic brain injury (TBI) have greater health-related complexity than veterans overall, and may require coordinated care from TBI specialists such as those within the Department of Veterans Affairs (VA) healthcare system. With passage of the Choice and MISSION Acts, more veterans are using VA-purchased care delivered by community providers who may lack TBI training. We explored prevalence and correlates of VA-purchased care use among post-9/11 veterans with TBI. SETTING Nationwide VA-purchased care from 2016 through 2019. PARTICIPANTS Post-9/11-era veterans with clinician-confirmed TBI based on VA's Comprehensive TBI Evaluation (N = 65 144). DESIGN This was a retrospective, observational study. MAIN MEASURES Proportions of veterans who used VA-purchased care and both VA-purchased and VA-delivered outpatient care, overall and by study year. We employed multivariable logistic regression to assess associations between veterans' sociodemographic, military history, and clinical characteristics and their likelihood of using VA-purchased care from 2016 through 2019. RESULTS Overall, 51% of veterans with TBI used VA-purchased care during the study period. Nearly all who used VA-purchased care (99%) also used VA-delivered outpatient care. Veterans' sociodemographic, military, and clinical characteristics were associated with their likelihood of using VA-purchased care. Notably, in adjusted analyses, veterans with moderate/severe TBI (vs mild), those with higher health risk scores, and those diagnosed with posttraumatic stress disorder, depression, anxiety, substance use disorders, or pain-related conditions had increased odds of using VA-purchased care. Additionally, those flagged as high risk for suicide also had higher odds of VA-purchased care use. CONCLUSIONS Veterans with TBI with greater health-related complexity were more likely to use VA-purchased care than their less complex counterparts. The risks of potential care fragmentation across providers versus the benefits of increased access to care are unknown. Research is needed to examine health and functional outcomes among these veterans.
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Affiliation(s)
- Diana J. Govier
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
- Oregon Health & Science University – Portland State University School of Public Health, Portland, OR
| | - Tess A. Gilbert
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
| | - R. Lorie Jacob
- Center of Innovation for Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL
| | - Megan Lafferty
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
| | - Abby Mulcahy
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
- Oregon Health & Science University – Portland State University School of Public Health, Portland, OR
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
- Boston University School of Public Health, Boston, MA
| | - Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
- Boston University Chobanian & Avedisian School of Medicine Section of General Internal Medicine, Boston, MA
| | - Maya E. O’Neil
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
- Oregon Health & Science University, Portland, OR
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT
- University of Utah, Salt Lake City, UT
| | - Kathleen F. Carlson
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR
- Oregon Health & Science University – Portland State University School of Public Health, Portland, OR
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Zade AP, Bhoge SS, Seth NH, Phansopkar P. Rehabilitation of Traumatic Acute Subdural Hematoma and Subarachnoid Hemorrhage: A Case Report. Cureus 2023; 15:e50660. [PMID: 38229824 PMCID: PMC10790600 DOI: 10.7759/cureus.50660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
A head injury or cerebrovascular illness may be the cause of acute intracranial hemorrhage. Making a precise diagnosis is challenging since diagnostic imaging might be challenging in both situations. In this case report, an aneurysmal rupture related head injury resulted in an acute subdural hematoma (SHD) after the patient lost consciousness. A 54-year-old male was found in a state of unconsciousness on the ground and was brought to the nearest hospital. Computed tomography (CT) scan showed an oblique fracture involving the bilateral frontal and right parietal bones along with underlying SDH, subarachnoid hemorrhage (SAH), and hemorrhagic contusion along with midline shift. The case report highlights the rehabilitation journey of a patient with acute SDH and SAH. The patient can now sit independently and stand with minimal assistance. Vasospasm detection, prevention, and treatment need to be the norm at that time. This case demonstrates the effectiveness of a comprehensive rehabilitation approach in promoting mobility and independence for patients with traumatic brain injuries.
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Affiliation(s)
- Amisha P Zade
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruti S Bhoge
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikita H Seth
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Norman R, Flaugher T, Chang S, Power E. Self-Perception of Cognitive-Communication Functions After Mild Traumatic Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:883-906. [PMID: 36645876 PMCID: PMC10166193 DOI: 10.1044/2022_ajslp-22-00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/01/2022] [Accepted: 10/19/2022] [Indexed: 05/10/2023]
Abstract
PURPOSE A mixed-method approach was used to investigate the lived experiences of adults with mild traumatic brain injury (mTBI). The study aimed to understand the perceived relationship between cognitive-communication problems, thinking and communication concerns, and neurobehavioral symptoms. We hypothesized that individuals with cognitive-communication problems would attribute their problems with communication to their mTBI history and their self-perceived problems would be correlated with symptomatology. METHOD The Neurobehavioral Symptom Inventory (NSI) and an online cognitive-communication survey was used to conduct a study of 30 adults with mTBI history. Quantitative survey and NSI scores were analyzed with content analysis and correlational statistics. RESULTS The average NSI Total score was 17 with the following subscale scores: somatic (5), affective (8), and cognitive (3.9). Participants reported problems with expressive communication (56%), comprehension (80%), thinking (63%), and social skills (60%). Content analysis revealed problems in the following areas: expression (e.g., verbal, and written language), comprehension (reading and verbal comprehension), cognition (e.g., attention, memory and speed of processing, error regulation), and functional consequences (e.g., academic work, social problems, and anxiety and stress). A Pearson correlation indicated a statistically significant relationship (p < .01) between the Communication Survey Total and the Total, Somatic, Affective, and Cognitive subscales. CONCLUSIONS This study highlights a multifactorial basis of cognitive-communication impairment in adults with mTBI. We show that those with mTBI history perceive difficulties with cognitive-communication skills: conversations, writing, and short-term memory/attention. Furthermore, those with mTBI perceive their cognitive-communication problems after injury have impacted their vocational, social, and academic success.
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Affiliation(s)
- Rocio Norman
- Department of Communication Sciences and Disorders, University of Texas Health Science Center at San Antonio
| | - Tara Flaugher
- Department of Neuroscience, Developmental and Regenerative Biology, University of Texas at San Antonio
| | - Sharon Chang
- Department of Otolaryngology—Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Emma Power
- University of Technology Sydney, Speech Pathology, New South Wales, Australia
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4
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Sullivan K, Keyter A, Jones K, Ameratunga S, Starkey N, Barker-Collo S, Webb J, Theadom A. Atypical symptom reporting after mild traumatic brain injury. BRAIN IMPAIR 2023; 24:114-123. [PMID: 38167586 DOI: 10.1017/brimp.2021.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Early reporting of atypical symptoms following a mild traumatic brain injury (mTBI) may be an early indicator of poor prognosis. This study aimed to determine the percentage of people reporting atypical symptoms 1-month post-mTBI and explore links to recovery 12 months later in a community-dwelling mTBI sample. METHODS Adult participants (>16 years) who had experienced a mTBI were identified from a longitudinal incidence study (BIONIC). At 1-month post-injury, 260 participants completed the Rivermead Post-Concussion Symptoms Questionnaire (typical symptoms) plus four atypical symptom items (hemiplegia, difficulty swallowing, digestion problems and difficulties with fine motor tasks). At 12 months post-injury, 73.9% (n = 193) rated their overall recovery on a 100-point scale. An ordinal regression explored the association between atypical symptoms at 1 month and recovery at 12 months post-injury (low = 0-80, moderate = 81-99 and complete recovery = 100), whilst controlling for age, sex, rehabilitation received, ethnicity, mental and physical comorbidities and additional injuries sustained at the time of injury. RESULTS At 1-month post-injury <1% of participants reported hemiplegia, 5.4% difficulty swallowing, 10% digestion problems and 15.4% difficulties with fine motor tasks. The ordinal regression model revealed atypical symptoms were not significant predictors of self-rated recovery at 12 months. Older age at injury and higher typical symptoms at 1 month were independently associated with poorer recovery at 12 months, p < 0.01. CONCLUSION Atypical symptoms on initial presentation were not linked to global self-reported recovery at 12 months. Age at injury and typical symptoms are stronger early indicators of longer-term prognosis. Further research is needed to determine if atypical symptoms predict other outcomes following mTBI.
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Affiliation(s)
- Karen Sullivan
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Anna Keyter
- Auckland University of Technology, Auckland, New Zealand
| | - Kelly Jones
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Nicola Starkey
- Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand
| | | | | | - Alice Theadom
- National Institute for Stroke and Applied Neuroscience, Auckland University of Technology, Auckland, New Zealand
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Psychiatric disorders in post-traumatic brain injury patients: A scoping review. Heliyon 2023; 9:e12905. [PMID: 36704272 PMCID: PMC9871203 DOI: 10.1016/j.heliyon.2023.e12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Background Traumatic Brain Injury (TBI) is an important antecedent in the evaluation of patients with psychiatric disorders. The association between TBI and the subsequent appearance of psychiatric disorders has been documented, however, the findings found in the literature are diverse and controversial. Objective To identify the most prevalent psychiatric disorders after head trauma. Design An exploratory review (SCOPING) was carried out using the PRISMA extension protocol. Articles published between the years 2010-2022 were used to identify and describe the most prevalent psychiatric disorders after a TBI. Psychiatric disorders were classified according to clinical characteristics in neurotic syndromes, psychotic syndromes, cognitive disorders, among others. Results A total of 32 articles were included. In the framework of neurotic syndromes, depression is the most prevalent psychiatric alteration after a TBI, becoming a sequel that shows a higher incidence in the first year after the traumatic event. The findings found in relation to post-traumatic stress disorder are controversial, showing great variability regarding the degree of severity of the injury. The prevalence of psychotic syndromes is relatively low because it is difficult to determine if the psychosis is a direct consequence of a TBI. In the cognitive sphere, it was found that people with TBI presented alterations in cognitive functions. Conclusions The findings found in the review respond to the hypothesis initially raised, which assumes that head trauma is an important etiological factor in the appearance of psychiatric disorders.
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Abstract
SUMMARY Sleep disorders are common after traumatic brain injury (TBI). This study will review the spectrum and proposed mechanisms of TBI-associated sleep disorders and discuss the clinical approach to diagnosis and management of them. Disordered and fragmented sleep with insomnia and daytime sleepiness is very common after TBI. Sleep disruption contributes to morbidity and neurocognitive and neurobehavioral deficits and prolongs the recovery phase after injury. Early recognition and correction of these problems may limit the secondary effects of TBI and improve patient outcomes. Evaluating sleep disorders in TBI should be an important component of TBI assessment and management. Finally, newer research techniques for early diagnosis, prognosis, and improved outcomes after TBI will also be addressed.
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Affiliation(s)
- Joseph Kaleyias
- Department of Paediatrics, East Sussex Health Care NHS Trust, London, United Kingdom
| | - Sanjeev V Kothare
- Division of Pediatric Neurology, Department of Pediatrics, Cohen Children's Medical Center, New York, New York, U.S.A.; and
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, U.S.A
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7
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Clark CN, Edwards MJ, Ong BE, Goodliffe L, Ahmad H, Dilley MD, Betteridge S, Griffin C, Jenkins PO. Reframing postconcussional syndrome as an interface disorder of neurology, psychiatry and psychology. Brain 2022; 145:1906-1915. [PMID: 35472071 PMCID: PMC9246708 DOI: 10.1093/brain/awac149] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Persistent symptoms following a minor head injury can cause significant morbidity, yet the underlying mechanisms for this are poorly understood. The shortcomings of the current terminology that refer to non-specific symptom clusters is discussed. This update considers the need for a multi-dimensional approach for the heterogenous mechanisms driving persistent symptoms after mild traumatic brain injury. Relevant pathophysiology is discussed to make the case for mild traumatic brain injury to be conceptualized as an interface disorder spanning neurology, psychiatry and psychology. The relevance of pre-injury factors, psychological co-morbidities and their interaction with the injury to produce persistent symptoms are reviewed. The interplay with psychiatric diagnoses, functional and somatic symptom disorder presentations and the influence of the medicolegal process is considered. The judicious use and interpretation of investigations given the above complexity is discussed, with suggestions of how the explanation of the diagnostic formulation to the patient can be tailored, including insight into the above processes, to aid recovery. Moving beyond the one-dimensional concept of 'postconcussional syndrome' and reframing the cause of persistent symptoms following mild traumatic brain injury in a bio-psycho-socio-ecological model will hopefully improve understanding of the underlying contributory mechanistic interactions and facilitate treatment.
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Affiliation(s)
- Camilla N Clark
- Institute of Molecular & Clinical Sciences, St George's University of London, SW17 0RE London, UK
- UK DRI Care Research and Technology Centre, Imperial College London, W12 0BZ London, UK
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Mark J Edwards
- Institute of Molecular & Clinical Sciences, St George's University of London, SW17 0RE London, UK
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Bee Eng Ong
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Luke Goodliffe
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Hena Ahmad
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Michael D Dilley
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Shai Betteridge
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Colette Griffin
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Peter O Jenkins
- UK DRI Care Research and Technology Centre, Imperial College London, W12 0BZ London, UK
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
- Neurology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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8
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TGF-β as a Key Modulator of Astrocyte Reactivity: Disease Relevance and Therapeutic Implications. Biomedicines 2022; 10:biomedicines10051206. [PMID: 35625943 PMCID: PMC9138510 DOI: 10.3390/biomedicines10051206] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/12/2022] [Accepted: 05/20/2022] [Indexed: 02/06/2023] Open
Abstract
Astrocytes are essential for normal brain development and functioning. They respond to brain injury and disease through a process referred to as reactive astrogliosis, where the reactivity is highly heterogenous and context-dependent. Reactive astrocytes are active contributors to brain pathology and can exert beneficial, detrimental, or mixed effects following brain insults. Transforming growth factor-β (TGF-β) has been identified as one of the key factors regulating astrocyte reactivity. The genetic and pharmacological manipulation of the TGF-β signaling pathway in animal models of central nervous system (CNS) injury and disease alters pathological and functional outcomes. This review aims to provide recent understanding regarding astrocyte reactivity and TGF-β signaling in brain injury, aging, and neurodegeneration. Further, it explores how TGF-β signaling modulates astrocyte reactivity and function in the context of CNS disease and injury.
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9
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Zogas A. "We have no magic bullet": Diagnostic ideals in veterans' mild traumatic brain injury evaluations. PATIENT EDUCATION AND COUNSELING 2022; 105:654-659. [PMID: 34127333 DOI: 10.1016/j.pec.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To understand military veterans' and healthcare providers' experiences identifying veterans' personal histories of combat-related mild traumatic brain injury (mTBI) months or years after the injury. METHODS Patients and clinical staff of a Veterans Health Administration (VA) Polytrauma/TBI clinic participated in a seven-month ethnographic study, which combined direct observation and interviews with veterans (n = 12) and VA clinicians (n = 11). Data were analyzed thematically. RESULTS Veterans and staff have different understandings of the value of neuroimaging in care for patients with post-acute mTBI, and different understandings of the role of diagnostic certainty in clinical care. Veterans sought to understand the relationship between their past head injuries and their current symptoms. Clinicians educated veterans that their symptoms could be caused by multiple factors and embraced ambiguity as part of treating this patient population. CONCLUSIONS Patient-provider communication may be enhanced by conversations about common norms of diagnosis and why evaluating mTBI histories departs from these norms. PRACTICE IMPLICATIONS Clinicians should anticipate that patients may expect a diagnostic process that entails neuroimaging and resolves their uncertainty. In the case of post-acute mTBI, patients would likely benefit from education about the diagnostic process, itself.
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Affiliation(s)
- Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
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Factors Influencing the Implementation of Guideline-recommended Practices for Post-concussive Sleep Disturbance and Headache in the Veterans Health Administration: A Mixed Methods Study. Arch Phys Med Rehabil 2022; 103:2153-2163. [DOI: 10.1016/j.apmr.2022.01.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/23/2022]
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Klyce DW, West SJ, Perrin PB, Agtarap SD, Finn JA, Juengst S, Dams-O'Connor K, Eagye CB, Vargas TA, Chung JS, Bombardier CH. Network Analysis of Neurobehavioral and Posttraumatic Stress Disorder Symptoms One Year after Traumatic Brain Injury: A Veterans Affairs TBI Model Systems Study. J Neurotrauma 2021; 38:3332-3340. [PMID: 34652955 DOI: 10.1089/neu.2021.0200] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Traumatic brain injury (TBI) is often experienced under stressful circumstances that can lead to both symptoms of posttraumatic stress disorder (PTSD) and neurobehavioral symptoms of brain injury. There is considerable symptom overlap in the behavioral expression of these conditions. Psychometric network analysis is a useful approach to investigate the role of specific symptoms in connecting these two disorders and is thus well-suited to explore their interrelatedness. This study applied network analysis to examine the associations among PTSD and TBI symptoms in a sample of Service Members and Veterans (SM/Vs) with a history of TBI one year after injury. Responses to the Neurobehavioral Symptom Inventory (NSI) and PTSC Checklist-Civilian version (PCL-C) were obtained from participants who completed comprehensive inpatient rehabilitation services at five VA polytrauma rehabilitation centers. Participants (N = 612) were 93.1% male with an average age of 36.98 years at injury. The analysis produced a stable network. Within the NSI symptom groups, the frustration symptom was an important bridge between the affective and cognitive TBI symptoms. The PCL-C nodes formed their own small cluster with hyperarousal yielding connections with the affective, cognitive, and somatic symptom groups. Consistent with this observation, the hyperarousal node had the second strongest bridge centrality in the network. Hyperarousal appears to play a key role in holding together this network of distress and thus represents a prime target for intervention among individuals with elevated symptoms of PTSD and a history of TBI. Network analysis offers an empirical approach to visualizing and quantifying the associations among symptoms. The identification of symptoms that are central to connecting multiple conditions can inform diagnostic precision and treatment selection.
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Affiliation(s)
- Daniel Wesley Klyce
- Richmond VAMC, 20125, 1201 Broad Rock Blvd, Richmond, Virginia, United States, 23249.,Sheltering Arms Institute, 559078, Richmond, United States, 23233-7632;
| | - Samuel J West
- Virginia Commonwealth University, 6889, Department of Psychology, Richmond, Virginia, United States;
| | - Paul B Perrin
- Virginia Commonwealth University, Department of Psychology, Richmond, United States;
| | | | - Jacob A Finn
- Minneapolis VA Health Care System, 20040, Minneapolis, Minnesota, United States.,University of Minnesota Department of Psychiatry, 172737, Minneapolis, Minnesota, United States;
| | - Shannon Juengst
- University of Texas Southwestern, Physical Medicine & Rehabilitation; Rehabilitation Counseling, 5323 Harry Hines Blvd, Dallas, Texas, United States, 75390-9055;
| | - Kristen Dams-O'Connor
- Icahn School of Medicine at Mount Sinai, 5925, Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, New York, United States, 10029; kristen.dams-o'
| | - C B Eagye
- Craig Hospital, 20588, Research Department, Englewood, Colorado, United States;
| | | | - Joyce S Chung
- Veterans Affairs Palo Alto Health Care System, Polytrauma, Palo Alto, California, United States;
| | - Charles H Bombardier
- University of Washington, Rehabilitation Medicine, Box 359612, Harborview Medical Center, 325 9th Avenue, Seattle, Washington, United States, 98104;
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12
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Adegboyega G, Zolo Y, Sebopelo LA, Dalle DU, Dada OE, Mbangtang CB, Tetinou F, Kanmounye US, Alalade AF. The Burden of Traumatic Brain Injury in Sub-Saharan Africa: A Scoping Review. World Neurosurg 2021; 156:e192-e205. [PMID: 34520864 DOI: 10.1016/j.wneu.2021.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the growing incidence of traumatic brain injury (TBI) in Sub-Saharan Africa, there is yet to be a study to map the current burden of the disease on the continent. This scoping review aims to outline the literature on TBI. METHODS This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews. A search string was developed to identify studies relating to TBI epidemiology, management, and outcomes. The search was applied to Medline, Embase, and Global Medicus Index. RESULTS In total, 107 studies were included in the final analysis. More than one half originated from South Africa. Seventy-five studies were published in 2013 or later. Studies recruited a median of 115 patients: 83.5 male and 31 female. TBI affected all age groups (range = 0-105 years) and sexes but was more common among young males aged 20-40. Road traffic accidents caused TBI in a median of 71 patients. Other major causes included assault (median = 39.5) and falls (median = 12.5). Craniectomies were the most commonly reported surgical treatment (18.7%) followed by burr holes (7.5%). Four studies (3.7%) reported delays in seeking neurotrauma care, with delays in reaching a neurotrauma facility and delays in receiving care being reported in 15 studies (14%) each. Glasgow Outcome Scale score was reported in 28 (26.1%) studies, whereas quality of life measures were reported in 2 (1%). Younger age was associated with favorable outcomes. CONCLUSIONS There is an increased need for TBI research, education, and training in Sub-Saharan Africa. This will aid stakeholders in optimizing patient management and outcome.
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Affiliation(s)
- Gideon Adegboyega
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.
| | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - David Ulrich Dalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | | | - Francklin Tetinou
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
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Luo Y, He X, Yang M, Du C, Jin X. A prognostic scoring system for operated acute epidural hematoma based on gray-white matter ratio. Medicine (Baltimore) 2021; 100:e26888. [PMID: 34414943 PMCID: PMC8376358 DOI: 10.1097/md.0000000000026888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To determine the prognostic risk factors of patients with acute epidural hematoma (AEDH), a scoring system was established based on gray-white matter ratio (GWR) and internal verification was performed.All patients with AEDH who underwent surgical treatment in Qinghai Provincial People's Hospital from January 2013 to June 2019 were continuously collected. The clinical and imaging data of the patients were collected. According to Glasgow Outcome Scale at 3 months after operation, the patients were divided into poor and good prognosis groups, respectively. The GWR value of the nonhematoma side was measured at the inner capsule area. Univariate and multivariate analyses were used. Independent predictors significantly related to the prognosis of AEDH were screened out and a nomogram was established based on these factors.A total of 170 cases were included in this study, the Glasgow Coma Score (severe and moderate), cerebral hernia, midline shift, preoperative GWR, postoperative GWR, hematoma thickness/midline shift, time from coma to surgery, and decompression of bone flap were the independent risk factors for predicting the poor prognosis of AEDH. Moreover, the prediction ability of nomogram was higher than any other independent predictive factors.The nomogram model established represents the most effective factor to predict the prognosis of operated AEDH. The scoring system is characterized by high accuracy, simplicity and feasibility, with a wide range of clinical application prospects.
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Affiliation(s)
- Yunxing Luo
- Graduate School, Qinghai University, Xining, Qinghai 810016, PR China
| | - Xiwu He
- Department of Neurosurgery, the Fifth People's Hospital of Qinghai Province, Xining, Qinghai 810007, PR China
| | - Mingfei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai 810007, PR China
| | - Chaonan Du
- Graduate School, Qinghai University, Xining, Qinghai 810016, PR China
| | - Xiaoqing Jin
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai 810007, PR China
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14
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Gerber LH, Deshpande R, Moosvi A, Zafonte R, Bushnik T, Garfinkel S, Cai C. Narrative review of clinical practice guidelines for treating people with moderate or severe traumatic brain injury. NeuroRehabilitation 2021; 48:451-467. [PMID: 34057100 PMCID: PMC8293642 DOI: 10.3233/nre-210024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND: Practice guidelines (CPGs) provide informed treatment recommendations from systematic reviews and assessment of the benefits and harms that are intended to optimize patient care. Review of CPGs addressing rehabilitation for people with moderate/severe traumatic brain injury (TBI), has not been fully investigated. OBJECTIVE: Identify published, vetted, clinical practice guidelines that address rehabilitation for people with moderate/severe TBI. METHODS: Six data bases were accessed using key word search terms: “Traumatic Brain Injury” and “Clinical Practice Guidelines” and “Rehabilitation”. Further inclusions included “adult” and “moderate or severe”. Exclusions included: “mild” and “concussive injury”. Three reviewers read abstracts and manuscripts for final inclusion. The AGREE II template was applied for additional appraisal. RESULTS: There were 767 articles retrieved using the search terms, 520 were eliminated because of content irrelevance; and 157 did not specify rehabilitation treatment or did not follow a process for CPGs. A total of 17 CPGs met all criteria and only 4 of these met all AGREE II criteria. CONCLUSION: There are few CPGs addressing rehabilitation for people with moderate/severe TBI. More interventional trials are needed to determine treatment effectiveness. Timely and methodologically sound vetting of studies are needed to ensure CPG reliability and facilitate access to quality, effective treatment for people with moderate/severe TBI.
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Affiliation(s)
- Lynn H Gerber
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Rati Deshpande
- Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Ali Moosvi
- Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Ross Zafonte
- Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Tamara Bushnik
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, USA
| | | | - Cindy Cai
- American Institute for Research, Arlington, VA, USA
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15
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Abstract
Traumatic brain injury is an increasing cause of morbidity worldwide. Neuropsychiatric impairments, such as behavioral dysregulation and depression, have significant impacts on recovery, functional outcomes, and quality of life of patients with traumatic brain injuries. Three patient cases, existing literature, and expert opinion are used to select pharmacotherapy for the treatment of target symptoms while balancing safety and tolerability.
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16
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Khodaei S, Avramescu S, Wang DS, Sheng H, Chan NK, Lecker I, Fernandez-Escobar A, Lei G, Dewar MB, Whissell PD, Baker AJ, Orser BA. Inhibiting α5 Subunit-Containing γ-Aminobutyric Acid Type A Receptors Attenuates Cognitive Deficits After Traumatic Brain Injury. Crit Care Med 2020; 48:533-544. [PMID: 32205600 DOI: 10.1097/ccm.0000000000004161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Cognitive deficits after traumatic brain injury are a leading cause of disability worldwide, yet no effective pharmacologic treatments exist to improve cognition. Traumatic brain injury increases proinflammatory cytokines, which trigger excess function of α5 subunit-containing γ-aminobutyric acid type A receptors. In several models of brain injury, drugs that inhibit α5 subunit-containing γ-aminobutyric acid type A receptor function improve cognitive performance. Thus, we postulated that inhibiting α5 subunit-containing γ-aminobutyric acid type A receptors would improve cognitive performance after traumatic brain injury. In addition, because traumatic brain injury reduces long-term potentiation in the hippocampus, a cellular correlate of memory, we studied whether inhibition of α5 subunit-containing γ-aminobutyric acid type A receptors attenuated deficits in long-term potentiation after traumatic brain injury. DESIGN Experimental animal study. SETTING Research laboratory. SUBJECTS Adult male mice and hippocampal brain slices. INTERVENTIONS Anesthetized mice were subjected to traumatic brain injury with a closed-head, free-weight drop method. One week later, the mice were treated with L-655,708 (0.5 mg/kg), an inhibitor that is selective for α5 subunit-containing γ-aminobutyric acid type A receptors, 30 minutes before undergoing behavioral testing. Problem-solving abilities were assessed using the puzzle box assay, and memory performance was studied with novel object recognition and object place recognition assays. In addition, hippocampal slices were prepared 1 week after traumatic brain injury, and long-term potentiation was studied using field recordings in the cornu Ammonis 1 region of slices that were perfused with L-655,708 (100 nM). MEASUREMENTS AND MAIN RESULTS Traumatic brain injury increased the time required to solve difficult but not simple tasks in the puzzle box assay and impaired memory in the novel object recognition and object place recognition assays. L-655,708 improved both problem solving and memory in the traumatic brain injury mice. Traumatic brain injury reduced long-term potentiation in the hippocampal slices, and L-655,708 attenuated this reduction. CONCLUSIONS Pharmacologic inhibition of α5 subunit-containing γ-aminobutyric acid type A receptors attenuated cognitive deficits after traumatic brain injury and enhanced synaptic plasticity in hippocampal slices. Collectively, these results suggest that α5 subunit-containing γ-aminobutyric acid type A receptors are novel targets for pharmacologic treatment of traumatic brain injury-induced persistent cognitive deficits.
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Affiliation(s)
- Shahin Khodaei
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Sinziana Avramescu
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dian-Shi Wang
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Heping Sheng
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Nathan K Chan
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Irene Lecker
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | | | - Gang Lei
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Michael B Dewar
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Paul D Whissell
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Andrew J Baker
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada
| | - Beverley A Orser
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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17
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Parrington L, Jehu DA, Fino PC, Stuart S, Wilhelm J, Pettigrew N, Murchison CF, El-Gohary M, VanDerwalker J, Pearson S, Hullar T, Chesnutt JC, Peterka RJ, Horak FB, King LA. The Sensor Technology and Rehabilitative Timing (START) Protocol: A Randomized Controlled Trial for the Rehabilitation of Mild Traumatic Brain Injury. Phys Ther 2020; 100:687-697. [PMID: 31951263 PMCID: PMC8493665 DOI: 10.1093/ptj/pzaa007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 11/16/2018] [Accepted: 10/04/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Clinical practice for rehabilitation after mild traumatic brain injury (mTBI) is variable, and guidance on when to initiate physical therapy is lacking. Wearable sensor technology may aid clinical assessment, performance monitoring, and exercise adherence, potentially improving rehabilitation outcomes during unsupervised home exercise programs. OBJECTIVE The objectives of this study were to: (1) determine whether initiating rehabilitation earlier than typical will improve outcomes after mTBI, and (2) examine whether using wearable sensors during a home-exercise program will improve outcomes in participants with mTBI. DESIGN This was a randomized controlled trial. SETTING This study will take place within an academic hospital setting at Oregon Health & Science University and Veterans Affairs Portland Health Care System, and in the home environment. PARTICIPANTS This study will include 160 individuals with mTBI. INTERVENTION The early intervention group (n = 80) will receive one-on-one physical therapy 8 times over 6 weeks and complete daily home exercises. The standard care group (n = 80) will complete the same intervention after a 6- to 8-week wait period. One-half of each group will receive wearable sensors for therapist monitoring of patient adherence and quality of movements during their home exercise program. MEASUREMENTS The primary outcome measure will be the Dizziness Handicap Inventory score. Secondary outcome measures will include symptomatology, static and dynamic postural control, central sensorimotor integration posturography, and vestibular-ocular-motor function. LIMITATIONS Potential limitations include variable onset of care, a wide range of ages, possible low adherence and/or withdrawal from the study in the standard of care group, and low Dizziness Handicap Inventory scores effecting ceiling for change after rehabilitation. CONCLUSIONS If initiating rehabilitation earlier improves primary and secondary outcomes post-mTBI, this could help shape current clinical care guidelines for rehabilitation. Additionally, using wearable sensors to monitor performance and adherence may improve home exercise outcomes.
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Affiliation(s)
- Lucy Parrington
- Department of Neurology, Oregon Health & Science University,
Portland, Oregon; and Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Deborah A Jehu
- Department of Neurology, Oregon Health & Science University;
Djavad Mowafaghian Centre for Brain Health, Centre for Hip Health and Mobility, and
Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia,
Canada
| | - Peter C Fino
- Department of Neurology, Oregon Health & Science University;
Veterans Affairs Portland Health Care System; and Department of Health, Kinesiology, and
Recreation, University of Utah, Salt Lake City, Utah
| | - Samuel Stuart
- Department of Neurology, Oregon Health & Science University;
and Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon
Tyne, United Kingdom
| | | | | | - Charles F Murchison
- Department of Neurology, Oregon Health & Science University;
and Department of Biostatistics at the University of Alabama, Birmingham, Alabama
| | | | | | | | - Timothy Hullar
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health
& Science University
| | - James C Chesnutt
- Departments of Family Medicine, Neurology, and Orthopedics &
Rehabilitation, Oregon Health & Science University
| | - Robert J Peterka
- National Center for Rehabilitative Auditory Research, Veterans
Affairs Portland Health Care System
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University;
Veterans Affairs Portland Health Care System; and APDM Inc
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University,
3181 SW Sam Jackson Park Rd, Portland, OR 97239 (USA); Veterans Affairs Portland Health Care
System; and National Center for Rehabilitative Auditory Research, Veterans Affairs Portland
Health Care System,Address all correspondence to Dr King at:
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18
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Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. Behav Res Ther 2019; 118:7-17. [DOI: 10.1016/j.brat.2019.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
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19
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Wagner AK, Kumar RG. TBI Rehabilomics Research: Conceptualizing a humoral triad for designing effective rehabilitation interventions. Neuropharmacology 2018; 145:133-144. [PMID: 30222984 DOI: 10.1016/j.neuropharm.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/14/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022]
Abstract
Most areas of medicine use biomarkers in some capacity to aid in understanding how personal biology informs clinical care. This article draws upon the Rehabilomics research model as a translational framework for programs of precision rehabilitation and intervention research focused on linking personal biology to treatment response using biopsychosocial constructs that broadly represent function and that can be applied to many clinical populations with disability. The summary applies the Rehabilomics research framework to the population with traumatic brain injury (TBI) and emphasizes a broad vision for biomarker inclusion, beyond typical brain-derived biomarkers, to capture and/or reflect important neurological and non-neurological pathology associated with TBI as a chronic condition. Humoral signaling molecules are explored as important signaling and regulatory drivers of these chronic conditions and their impact on function. Importantly, secondary injury cascades involved in the humoral triad are influenced by the systemic response to TBI and the development of non-neurological organ dysfunction (NNOD). Biomarkers have been successfully leveraged in other medical fields to inform pre-randomization patient selection for clinical trials, however, this practice largely has not been utilized in TBI research. As such, the applicability of the Rehabilomics research model to contemporary clinical trials and comparative effectiveness research designs for neurological and rehabilitation populations is emphasized. Potential points of intervention to modify inflammation, hormonal, or neurotrophic support through rehabilitation interventions are discussed. This article is part of the Special Issue entitled "Novel Treatments for Traumatic Brain Injury".
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Affiliation(s)
- A K Wagner
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, USA; Safar Center for Resuscitation Research, University of Pittsburgh, USA; Department of Neuroscience, University of Pittsburgh, USA; Center for Neuroscience, University of Pittsburgh, USA.
| | - R G Kumar
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, USA; Safar Center for Resuscitation Research, University of Pittsburgh, USA; Department of Epidemiology, University of Pittsburgh, USA
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