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Johansen T, Matre M, Løvstad M, Lund A, Martinsen AC, Olsen A, Becker F, Brunborg C, Ponsford J, Spikman J, Neumann D, Tornås S. Virtual reality as a method of cognitive training of processing speed, working memory, and sustained attention in persons with acquired brain injury: a protocol for a randomized controlled trial. Trials 2024; 25:340. [PMID: 38778411 PMCID: PMC11110309 DOI: 10.1186/s13063-024-08178-7] [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: 08/02/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Acquired brain injury (ABI) often leads to persisting somatic, cognitive, and social impairments. Cognitive impairments of processing speed, sustained attention, and working memory are frequently reported and may negatively affect activities of daily living and quality of life. Rehabilitation efforts aiming to retrain these cognitive functions have often consisted of computerized training programs. However, few studies have demonstrated effects that transfer beyond the trained tasks. There is a growing optimism regarding the potential usefulness of virtual reality (VR) in cognitive rehabilitation. The research literature is sparse, and existing studies are characterized by considerable methodological weaknesses. There is also a lack of knowledge about the acceptance and tolerability of VR as an intervention method for people with ABI. The present study aims to investigate whether playing a commercially available VR game is effective in training cognitive functions after ABI and to explore if the possible effects transfer into everyday functioning. METHODS One hundred participants (18-65 years), with a verified ABI, impairments of processing speed/attention, and/or working memory, and a minimum of 12 months post injury will be recruited. Participants with severe aphasia, apraxia, visual neglect, epilepsy, and severe mental illness will be excluded. Participants will be randomized into two parallel groups: (1) an intervention group playing a commercial VR game taxing processing speed, working memory, and sustained attention; (2) an active control group receiving psychoeducation regarding compensatory strategies, and general cognitive training tasks such as crossword puzzles or sudoku. The intervention period is 5 weeks. The VR group will be asked to train at home for 30 min 5 days per week. Each participant will be assessed at baseline with neuropsychological tests and questionnaires, after the end of the intervention (5 weeks), and 16 weeks after baseline. After the end of the intervention period, focus group interviews will be conducted with 10 of the participants in the intervention group, in order to investigate acceptance and tolerability of VR as a training method. DISCUSSION This study will contribute to improve understanding of how VR is tolerated and experienced by the ABI population. If proven effective, the study can contribute to new rehabilitation methods that persons with ABI can utilize in a home setting, after the post-acute rehabilitation has ended.
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Affiliation(s)
- T Johansen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway.
- Department of Occupational Therapy, Institute of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - M Matre
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - M Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - A Lund
- Department of Occupational Therapy, Institute of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - A C Martinsen
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - A Olsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- NorHEAD - Norwegian Centre for Headache Research, Trondheim, Norway
| | - F Becker
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
- Department of Physical Medicine and Rehabilitation, University of Oslo, Oslo, Norway
| | - C Brunborg
- Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital, Oslo, Norway
| | - J Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, Australia
| | - J Spikman
- Department of Neurology, Subdepartment of Neuropsychology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - D Neumann
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, USA
| | - S Tornås
- Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway
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Babbage DR, Drown JC, Van Solkema M, Armstrong J, Levack W, Kayes N. Inpatient trial of a tablet app for communicating brain injury rehabilitation goals. Disabil Rehabil Assist Technol 2024; 19:1287-1297. [PMID: 36634029 DOI: 10.1080/17483107.2023.2167009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE We examine the use of a custom iPad application, the Rehab Portal, to provide clients in an inpatient brain injury rehabilitation service with access to short videos where clinicians-or the clients themselves-discuss their current rehabilitation goals. MATERIALS AND METHODS We developed an initial version of the Rehab Portal app based on our previous co-design with service users, their families, and clinicians. This was examined in a field trial with a series of six clients over the course of their stays in inpatient rehabilitation, collecting quantitative data on clinician and client engagement with the Rehab Portal, alongside a thematic analysis of qualitative interviews with clients and clinicians at the point of discharge. RESULTS Engagement with the platform was high for two clients while it was limited with four more. In our thematic analysis we discuss how introduction of the Rehab Portal disrupted practice, changing how things are done, causing deviation from usual routines, adding burden, and threatening professional integrity. At the same time, where it worked well it led to a repositioning of goal planning away from being clinician directed and towards an ongoing, dynamic collaboration between clinicians, clients and their families. Finally, in some cases we identified a reverting to the status quo, with client demotivation having an unexpected impact on clinician behaviour leading to the process being abandoned. CONCLUSIONS The current findings do not provide wholesale support for this approach, yet we continue to feel that approaches that support clinician-client communication using asynchronous video may offer considerable future value and are worthy of further investigation.
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Affiliation(s)
- Duncan R Babbage
- Centre for eHealth, Auckland University of Technology, Auckland, New Zealand
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Juliet C Drown
- Centre for eHealth, Auckland University of Technology, Auckland, New Zealand
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Maegan Van Solkema
- Clinical Lead Speech Language Therapist, ABI Rehabilitation NZ Ltd, Auckland, New Zealand
| | - Jonathan Armstrong
- Director of Rehabilitation, ABI Rehabilitation NZ Ltd, Auckland, New Zealand
| | - William Levack
- Rehabilitation Teaching & Research Unit, University of Otago, Dunedin, New Zealand
| | - Nicola Kayes
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
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Kanser RJ, Rapport LJ, Hanks RA, Patrick SD. Time and money: Exploring enhancements to performance validity research designs. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:256-263. [PMID: 34932422 DOI: 10.1080/23279095.2021.2019740] [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: 06/14/2023]
Abstract
INTRODUCTION The study examined the effect of preparation time and financial incentives on healthy adults' ability to simulate traumatic brain injury (TBI) during neuropsychological evaluation. METHOD A retrospective comparison of two TBI simulator group designs: a traditional design employing a single-session of standard coaching immediately before participation (SIM-SC; n = 46) and a novel design that provided financial incentive and preparation time (SIM-IP; n = 49). Both groups completed an ecologically valid neuropsychological test battery that included widely-used cognitive tests and five common performance validity tests (PVTs). RESULTS Compared to SIM-SC, SIM-IP performed significantly worse and had higher rates of impairment on tests of processing speed and executive functioning (Trails A and B). SIM-IP were more likely than SIM-SC to avoid detection on one of the PVTs and performed somewhat better on three of the PVTs, but the effects were small and non-significant. SIM-IP did not demonstrate significantly higher rates of successful simulation (i.e., performing impaired on cognitive tests with <2 PVT failures). Overall, the rate of the successful simulation was ∼40% with a liberal criterion, requiring cognitive impairment defined as performance >1 SD below the normative mean. At a more rigorous criterion defining impairment (>1.5 SD below the normative mean), successful simulation approached 35%. CONCLUSIONS Incentive and preparation time appear to add limited incremental effect over traditional, single-session coaching analog studies of TBI simulation. Moreover, these design modifications did not translate to meaningfully higher rates of successful simulation and avoidance of detection by PVTs.
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Affiliation(s)
- Robert J Kanser
- Department of Psychology, Wayne State University, Detroit, MI, USA
- Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Robin A Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI, USA
| | - Sarah D Patrick
- Department of Psychology, Wayne State University, Detroit, MI, USA
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Martínez-Molina N, Sanz-Perl Y, Escrichs A, Kringelbach ML, Deco G. Turbulent dynamics and whole-brain modeling: toward new clinical applications for traumatic brain injury. Front Neuroinform 2024; 18:1382372. [PMID: 38590709 PMCID: PMC10999628 DOI: 10.3389/fninf.2024.1382372] [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: 02/05/2024] [Accepted: 03/01/2024] [Indexed: 04/10/2024] Open
Abstract
Traumatic Brain Injury (TBI) is a prevalent disorder mostly characterized by persistent impairments in cognitive function that poses a substantial burden on caregivers and the healthcare system worldwide. Crucially, severity classification is primarily based on clinical evaluations, which are non-specific and poorly predictive of long-term disability. In this Mini Review, we first provide a description of our model-free and model-based approaches within the turbulent dynamics framework as well as our vision on how they can potentially contribute to provide new neuroimaging biomarkers for TBI. In addition, we report the main findings of our recent study examining longitudinal changes in moderate-severe TBI (msTBI) patients during a one year spontaneous recovery by applying the turbulent dynamics framework (model-free approach) and the Hopf whole-brain computational model (model-based approach) combined with in silico perturbations. Given the neuroinflammatory response and heightened risk for neurodegeneration after TBI, we also offer future directions to explore the association with genomic information. Moreover, we discuss how whole-brain computational modeling may advance our understanding of the impact of structural disconnection on whole-brain dynamics after msTBI in light of our recent findings. Lastly, we suggest future avenues whereby whole-brain computational modeling may assist the identification of optimal brain targets for deep brain stimulation to promote TBI recovery.
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Affiliation(s)
- Noelia Martínez-Molina
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Yonatan Sanz-Perl
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Anira Escrichs
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Morten L. Kringelbach
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Department of Clinical Medicine, Center for Music in the Brain, Aarhus University and The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark
| | - Gustavo Deco
- Computational Neuroscience Group, Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de la Recerca i Estudis Avançats, Barcelona, Spain
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Boyapati RM, Nehrbas J, Yarboro SR, Hadeed MM. Traumatic brain injury is common and undertreated in the orthopaedic trauma population. Injury 2024; 55:111325. [PMID: 38241955 DOI: 10.1016/j.injury.2024.111325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Traumatic brain injuries (TBIs) can be difficult to diagnose and are often marginalized when compared to more obvious physical injuries. Despite this, recognition and early treatment can lead to improved outcomes. Even mild TBIs have the potential to cause significant long-term consequences for patients, which may affect their physical recovery from orthopaedic injuries. The objective of this study was to examine the incidence and treatment of TBI within the orthopaedic trauma population. METHODS Inclusion criteria were all patients presenting after an acute trauma with an orthopaedic surgery consult over a continuous 3 month timeframe (n = 187). A retrospective review was completed at an academic tertiary referral trauma center. The primary outcome was the rate of TBI. Secondary outcomes included rate of TBI listed as a discharge diagnosis and rate of follow up plan. Several secondary variables were noted and their associations with TBI evaluated. RESULTS 27 % of the 187 patients had an acute TBI. 61 % of TBI patients had the diagnosis listed in their discharge summary. 6 % had a follow up plan. The positive TBI group was associated with more high energy injuries (p = 0.032), average limbs involved (p = 0.007), upper extremity injury (p < 0.001), bilateral lower extremity injury (p = 0.004), and Injury Severity Score (p < 0.001). 82 % of patients with an acute TBI had an occupational therapy consult and 39 % had a neurosurgery consult. 24 % of patients with a TBI were admitted to the orthopaedic primary service. CONCLUSIONS Patients presenting after an acute trauma with orthopaedic injuries have high rates of TBI, but low rates of diagnosis and treatment. This lack of diagnosis and treatment can negatively impact recovery from orthopaedic injuries. Orthopaedic providers should be aware of the diagnostic criteria and initial treatment steps for TBI to ensure prompt and effective treatment, which has been shown to improve outcomes.
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Affiliation(s)
- Rohan M Boyapati
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States
| | - Jill Nehrbas
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States
| | - Seth R Yarboro
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States
| | - Michael M Hadeed
- University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States.
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Tabet S, Laguë-Beauvais M, Francoeur C, Sheehan A, Abouassaly M, Marcoux J, Dagher JH, Ursulet A, Colucci E, de Guise E. Longitudinal recovery of executive functions and social participation prediction following traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:134-143. [PMID: 34807801 DOI: 10.1080/23279095.2021.2002866] [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: 06/13/2023]
Abstract
There is heterogeneity across studies and a lack of knowledge about recovery of EFs over time following traumatic brain injury (TBI). Also, EFs are associated with functional outcome, but there is still a gap in knowledge concerning the association between EFs and social participation following TBI. For this reason, we aim to (1) measure the recovery of the three executive function subcomponents of Miyake's model, namely flexibility, updating and inhibition between the acute phase (T1) and 6 months post TBI (T2) and (2) measure the relationship between EFs and social participation after TBI. Thus, a prospective longitudinal study that included 75 patients with TBI (mild and moderate-severe) and 50 patients with orthopedic injuries (controls) without brain damage was carried out. An extensive EFs test battery was administered at T1 and T2 whereas the Mayo-Portland Adaptability Inventory-4 (MPAI-4) was administered only at T2. In contrast with the controls, both TBI groups improved significantly between T1 and T2 on WMS-III Mental Control test (MC) and the D-KEFS Category Switching Condition of the Verbal Fluency task (SVF). Results also showed a simple time effect for the WAIS-IV Digit span and the Hayling tests. Moreover, there was an association between the SVF test and social participation (MPAI-4) at T2. In conclusion, the MC and SVF tests were found to be the best tools for measuring recovery of EFs following TBI. The SVF test was the most likely measure of EFs to give the neuropsychologist an idea of the patient's social participation.
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Affiliation(s)
- Sabrina Tabet
- Department of Psychology, Université de Montréal, Laval, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montreal, Canada
| | - Maude Laguë-Beauvais
- Department of Psychology, Université de Montréal, Laval, Canada
- Traumatic brain Injury Program, McGill University Health Center, Montreal, Canada
| | - Coralie Francoeur
- Department of Psychology, Université de Montréal, Laval, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montreal, Canada
| | - Audrey Sheehan
- Department of Psychology, Université de Montréal, Laval, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montreal, Canada
| | - Michel Abouassaly
- Traumatic brain Injury Program, McGill University Health Center, Montreal, Canada
| | - Judith Marcoux
- Traumatic brain Injury Program, McGill University Health Center, Montreal, Canada
| | - Jehane H Dagher
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montreal, Canada
- Traumatic brain Injury Program, McGill University Health Center, Montreal, Canada
- Physical Medicine and Rehabilitation Service, McGill University Health Centre-Montreal General Hospital, Quebec, Canada
| | - Adriana Ursulet
- Department of Psychology, Université de Montréal, Laval, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montreal, Canada
| | - Emma Colucci
- Department of Psychology, Université de Montréal, Laval, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montreal, Canada
| | - Elaine de Guise
- Department of Psychology, Université de Montréal, Laval, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR) , Montreal, Canada
- Research Institute-McGill University Health Center, Montreal, Canada
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Domensino AF, Tas J, Donners B, Kooyman J, van der Horst ICC, Haeren R, Ariës MJH, van Heugten C. Long-Term Follow-Up of Critically Ill Patients With Traumatic Brain Injury: From Intensive Care Parameters to Patient and Caregiver-Reported Outcome. J Neurotrauma 2024; 41:123-134. [PMID: 37265152 DOI: 10.1089/neu.2022.0474] [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: 06/03/2023] Open
Abstract
Abstract Traumatic brain injury (TBI) is associated with a high social and financial burden due to persisting (severe) disabilities. The consequences of TBI after intensive care unit (ICU) admission are generally measured with global disability screeners such as the Glasgow Outcome Scale-Extended (GOSE), which may lack precision. To improve outcome measurement after brain injury, a comprehensive clinical outcome assessment tool called the Minimal Dataset for Acquired Brain Injury (MDS-ABI) was recently developed. The MDS-ABI covers 12 life domains (demographics, injury characteristics, comorbidity, cognitive functioning, emotional functioning, energy, mobility, self-care, communication, participation, social support, and quality of life), as well as informal caregiver capacity and strain. In this cross-sectional study, we used the MDS-ABI among formerly ICU admitted patients with TBI to explore the relationship between dichotomized severity of TBI and long-term outcome. Our objectives were to: 1) summarize demographics, clinical characteristics, and long-term outcomes of patients and their informal caregivers, and 2) compare differences between long-term outcomes in patients with mild-moderate TBI and severe TBI based on Glasgow Coma Scale (GCS) scores at admission. Participants were former patients of a Dutch university hospital (total n = 52; mild-moderate TBI n = 23; severe TBI n = 29) and their informal caregivers (n = 45). Hospital records were evaluated, and the MDS-ABI was administered during a home visit. On average 3.2 years after their TBI, 62% of the patients were cognitively impaired, 62% reported elevated fatigue, and 69% experienced restrictions in ≥2 participation domains (most frequently work or education and going out). Informal caregivers generally felt competent to provide necessary care (81%), but 31% experienced a disproportionate caregiver burden. All but four patients lived at home independently, often together with their informal caregiver (81%). Although the mild-moderate TBI group and the severe TBI group had significantly different clinical trajectories, there were no persisting differences between the groups for patient or caregiver outcomes at follow-up. As a large proportion of the patients experienced long-lasting consequences beyond global disability or independent living, clinicians should implement a multi-domain outcome set such as the MDS-AB to follow up on their patients.
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Affiliation(s)
- Anne-Fleur Domensino
- School for Mental Health and Neuroscience (MHeNS), Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Jeanette Tas
- School for Mental Health and Neuroscience (MHeNS), Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Babette Donners
- Department of Intensive Care Medicine, Maastricht University, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Joyce Kooyman
- School for Mental Health and Neuroscience (MHeNS), Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Roel Haeren
- School for Mental Health and Neuroscience (MHeNS), Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marcel J H Ariës
- School for Mental Health and Neuroscience (MHeNS), Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Caroline van Heugten
- School for Mental Health and Neuroscience (MHeNS), Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, The Netherlands
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Schiff ND, Giacino JT, Butson CR, Choi EY, Baker JL, O'Sullivan KP, Janson AP, Bergin M, Bronte-Stewart HM, Chua J, DeGeorge L, Dikmen S, Fogarty A, Gerber LM, Krel M, Maldonado J, Radovan M, Shah SA, Su J, Temkin N, Tourdias T, Victor JD, Waters A, Kolakowsky-Hayner SA, Fins JJ, Machado AG, Rutt BK, Henderson JM. Thalamic deep brain stimulation in traumatic brain injury: a phase 1, randomized feasibility study. Nat Med 2023; 29:3162-3174. [PMID: 38049620 PMCID: PMC11087147 DOI: 10.1038/s41591-023-02638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/10/2023] [Indexed: 12/06/2023]
Abstract
Converging evidence indicates that impairments in executive function and information-processing speed limit quality of life and social reentry after moderate-to-severe traumatic brain injury (msTBI). These deficits reflect dysfunction of frontostriatal networks for which the central lateral (CL) nucleus of the thalamus is a critical node. The primary objective of this feasibility study was to test the safety and efficacy of deep brain stimulation within the CL and the associated medial dorsal tegmental (CL/DTTm) tract.Six participants with msTBI, who were between 3 and 18 years post-injury, underwent surgery with electrode placement guided by imaging and subject-specific biophysical modeling to predict activation of the CL/DTTm tract. The primary efficacy measure was improvement in executive control indexed by processing speed on part B of the trail-making test.All six participants were safely implanted. Five participants completed the study and one was withdrawn for protocol non-compliance. Processing speed on part B of the trail-making test improved 15% to 52% from baseline, exceeding the 10% benchmark for improvement in all five cases.CL/DTTm deep brain stimulation can be safely applied and may improve executive control in patients with msTBI who are in the chronic phase of recovery.ClinicalTrials.gov identifier: NCT02881151 .
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Affiliation(s)
- Nicholas D Schiff
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA.
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Christopher R Butson
- Scientific Computing and Imaging Institute Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
- Norman Fixel Institute for Neurological Diseases Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Eun Young Choi
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Jonathan L Baker
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA
| | - Kyle P O'Sullivan
- Scientific Computing and Imaging Institute Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Andrew P Janson
- Scientific Computing and Imaging Institute Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
- Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Michael Bergin
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | | | - Jason Chua
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Laurel DeGeorge
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Adam Fogarty
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Linda M Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark Krel
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Jose Maldonado
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - Matthew Radovan
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Sudhin A Shah
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Jason Su
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Thomas Tourdias
- Department of Neuroimaging, University of Bordeaux, Nouvelle-Aquitaine, France
| | - Jonathan D Victor
- Feil Family Brain Mind Institute, Weill Cornell Medicine, New York, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Abigail Waters
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | | | - Joseph J Fins
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Andre G Machado
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian K Rutt
- Department of Radiology, Stanford University, Stanford, CA, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
- Bio-X Program, Stanford University, Stanford, CA, USA
| | - Jaimie M Henderson
- Department of Neurosurgery, Stanford University, Stanford, CA, USA.
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
- Bio-X Program, Stanford University, Stanford, CA, USA.
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9
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Dresch Vascouto H, Melo HM, de Oliveira Thais MER, Schwarzbold ML, Lin K, Pizzol FD, Kupek E, Walz R. Cognitive Performance of Brazilian Patients With Favorable Outcomes After Severe Traumatic Brain Injury: A Prospective Study. Am J Phys Med Rehabil 2023; 102:1070-1075. [PMID: 37204939 DOI: 10.1097/phm.0000000000002279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the cognitive performance of patients with favorable outcomes, determined by the Glasgow Outcome Scale, 1 yr after hospital discharge due to severe traumatic brain injury. DESIGN This was a prospective case-control study. From 163 consecutive adult patients with severe traumatic brain injury included in the study, 73 patients had a favorable outcome (Glasgow Outcome Scale score of 4 or 5) 1 yr after hospital discharge and were eligible for the cognitive evaluation, of which 28 completed the evaluations. The latter were compared with 44 healthy controls. RESULTS The average loss of cognitive performance among participants with traumatic brain injury varied between 13.35% and 43.49% compared with the control group. Between 21.4% and 32% of the patients performed below the 10th percentile on three language tests and two verbal memory tests, whereas 39% to 50% performed below this threshold on one language test and three memory tests. Longer hospital stay, older age, and lower education were the most important predictors of worse cognitive performance. CONCLUSION One year after a severe traumatic brain injury, a significant proportion of Brazilian patients with the favorable outcome determined by Glasgow Outcome Scale still showed significant cognitive impairment in verbal memory and language domains.
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Affiliation(s)
- Helena Dresch Vascouto
- From the Center for Applied Neuroscience (CeNAp), Department of Clinical Medicine, University Hospital-UFSC (HU-UFSC) (HDV, HMM, MLS, KL, RW), Graduate Program in Neuroscience (HDV, HMM, MERdOT, RW), Graduate Program in Medical Sciences (MERdOT, MLS, KL, RW), Psychiatry Unit, Department of Internal Medicine, University Hospital (HU) (MLS), Neurology Unit, Department of Internal Medicine, University Hospital-UFSC (HU-UFSC) (KL, RW), and Department of Public Health (EK), Federal University of Santa Catarina (UFSC), Florianópolis/SC; and Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Graduate Program in Health Sciences, Health Sciences Unit, University of South Santa Catarina, Santa Catarina, Brazil (FDP)
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10
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Wright BM, Zhang C, Fisher RR, Karmarkar AM, Bjork JM, Pugh MJ, Hodges CB, Martindale SL, Wilde EA, Kenney K, McDonald SD, Scheibel RS, Newsome MR, Cook LJ, Walker WC. Relation of Aerobic Activity to Cognition and Well-being in Chronic Mild Traumatic Brain Injury: A LIMBIC-CENC Study. Mil Med 2023; 188:124-133. [PMID: 37948207 DOI: 10.1093/milmed/usad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Because chronic difficulties with cognition and well-being are common after mild traumatic brain injury (mTBI) and aerobic physical activity and exercise (PAE) is a potential treatment and mitigation strategy, we sought to determine their relationship in a large sample with remote mTBI. MATERIALS AND METHODS The Long-Term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium prospective longitudinal study is a national multicenter observational study of combat-exposed service members and veterans. Study participants with positive mTBI histories (n = 1,087) were classified as "inactive" (23%), "insufficiently active" (46%), "active" (19%), or "highly active" (13%) based on the aerobic PAE level. The design was a cross-sectional analysis with multivariable regression. PAE was reported on the Behavioral Risk Factor Surveillance System. Preselected primary outcomes were seven well-validated cognitive performance tests of executive function, learning, and memory: The California Verbal Learning Test-Second Edition Long-Delay Free Recall and Total Recall, Brief Visuospatial Memory Test-Revised Total Recall, Trail-Making Test-Part B, and NIH Toolbox for the Assessment of Neurological Behavior and Function Cognition Battery Picture Sequence Memory, Flanker, and Dimensional Change Card Sort tests. Preselected secondary outcomes were standardized self-report questionnaires of cognitive functioning, life satisfaction, and well-being. RESULTS Across the aerobic activity groups, cognitive performance tests were not significantly different. Life satisfaction and overall health status scores were higher for those engaging in regular aerobic activity. Exploratory analyses also showed better working memory and verbal fluency with higher aerobic activity levels. CONCLUSIONS An association between the aerobic activity level and the preselected primary cognitive performance outcome was not demonstrated using this study sample and methods. However, higher aerobic activity levels were associated with better subjective well-being. This supports a clinical recommendation for regular aerobic exercise among persons with chronic or remote mTBI. Future longitudinal analyses of the exercise-cognition relationship in chronic mTBI populations are recommended.
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Affiliation(s)
- Brennan M Wright
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84108, USA
| | - Renae R Fisher
- Department of Rehabilitation Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA 19107, USA
| | - Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Sheltering Arms Institute, Richmond, VA 23233, USA
| | - James M Bjork
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Mental Health Service, Central Virginia VA Health Care System, Richmond, VA 23249, USA
| | - Mary Jo Pugh
- VA Salt Lake City IDEAS Center for Innovation and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84312, USA
| | - Cooper B Hodges
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Research Service Line, Washington DC VA Medical Center, Washington, DC 20422, USA
| | - Sarah L Martindale
- Research & Academic Affairs Service Line, W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC 28144, USA
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Elisabeth A Wilde
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, UT 84148, USA
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kimbra Kenney
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Scott D McDonald
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- Mental Health Service, Central Virginia VA Health Care System, Richmond, VA 23249, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Randall S Scheibel
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Mary R Newsome
- Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
| | - Lawrence J Cook
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
| | - William C Walker
- Department of Physical Medicine and Rehabilitation (PM&R), Virginia Commonwealth University, Richmond, VA 23284-0667, USA
- PM&R Service, Richmond Veterans Affairs Medical Center, Richmond, VA 23249, USA
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Briscoe J, Doherty J, Burgess K, Kent C. Errorful learning improves recognition memory for new vocabulary for people living with memory and dysexecutive impairment following brain injury. Neuropsychol Rehabil 2023:1-31. [PMID: 37733957 DOI: 10.1080/09602011.2023.2259017] [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: 03/13/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
A widely accepted view is that errorless learning is essential for supporting new learning in people with anterograde amnesia, but findings are mixed for those with a broader range of memory impairments. People at a chronic stage of recovery from brain injury (BI) with impaired memory and executive function (N = 26) were compared with adults in a comparison group without any known risks to brain function (N = 25). Learning techniques were compared using a "Generate-and-correct" and "Read-only" condition when learning novel word pairs. At test, both groups scored above chance and showed benefits of Generate-and-correct (errorful learning). Poor learners in the BI group were classified from "flat" learning slopes extracted from an independent word-pair learning task. Critically, poor learners showed no benefit, but also no decrement to learning, using the Generate-and-correct method. No group was harmed by errorful learning; all, except the poorest learners, benefitted from errorful learning. This study indicates, that in some rehabilitation settings, encouraging clients to guess the meaning of unfamiliar material (e.g., from cards, magazines, newspapers) and then correct their errors, could have benefits for recognition memory. Determining when and how errorful learning benefits learning is a key aim for future research.
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Affiliation(s)
- Josie Briscoe
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Joanna Doherty
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Katy Burgess
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychology, Cardiff University, Cardiff, UK
| | - Christopher Kent
- School of Psychological Science, University of Bristol, Bristol, UK
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12
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Pieniak M, Seidel K, Oleszkiewicz A, Gellrich J, Karpinski C, Fitze G, Schriever VA. Olfactory training effects in children after mild traumatic brain injury. Brain Inj 2023; 37:1272-1284. [PMID: 37486172 DOI: 10.1080/02699052.2023.2237889] [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: 11/09/2022] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE Mild traumatic brain injury (mTBI) might impair the sense of smell and cognitive functioning. Repeated, systematic exposure to odors, i.e., olfactory training (OT) has been proposed for treatment of olfactory dysfunctions, including post-traumatic smell loss. Additionally, OT has been shown to mitigate cognitive deterioration in older population and enhance selected cognitive functions in adults. We aimed to investigate olfactory and cognitive effects of OT in the pediatric population after mTBI, likely to exhibit cognitive and olfactory deficits. METHODS Our study comprised 159 children after mTBI and healthy controls aged 6-16 years (M = 9.68 ± 2.78 years, 107 males), who performed 6-months-long OT with a set of 4 either high- or low-concentrated odors. Before and after OT we assessed olfactory functions, fluid intelligence, and executive functions. RESULTS OT with low-concentrated odors increased olfactory sensitivity in children after mTBI. Regardless of health status, children who underwent OT with low-concentrated odors had higher fluid intelligence scores at post-training measurement, whereas scores of children performing OT with high-concentrated odors did not change. CONCLUSION Our study suggests that OT with low-concentrated odors might accelerate rehabilitation of olfactory sensitivity in children after mTBI and support cognitive functions in the area of fluid intelligence regardless of head trauma.
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Affiliation(s)
- Michal Pieniak
- Smell & Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Faculty of Historical and Pedagogical Sciences, Institute of Psychology, University of Wrocław, Wroclaw, Poland
| | - Katharina Seidel
- Abteilung Neuropädiatrie, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anna Oleszkiewicz
- Smell & Taste Clinic, Department of Otorhinolaryngology, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Faculty of Historical and Pedagogical Sciences, Institute of Psychology, University of Wrocław, Wroclaw, Poland
| | - Janine Gellrich
- Abteilung Neuropädiatrie, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Karpinski
- Klinik Und Poliklinik Für Kinderchirurgie, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Guido Fitze
- Klinik Und Poliklinik Für Kinderchirurgie, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Valentin A Schriever
- Abteilung Neuropädiatrie, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Center for Chronically Sick Children (Sozialpädiatrisches Zentrum, SPZ), Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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El Haj M, Moustafa AA, Allain P. Memory in Social Interactions: The Effects of Introspection on Destination Memory in Traumatic Brain Injury. Brain Sci 2023; 13:1250. [PMID: 37759851 PMCID: PMC10526270 DOI: 10.3390/brainsci13091250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Destination memory, which is the ability to remember to whom one has sent information, is intimately associated with social cognition. We assessed whether processing attributes of destinations would improve destination memory in patients with traumatic brain injury (TBI). In this cross-sectional study, we tested the destination memory of 24 patients with TBI and 25 control participants in two conditions. On the first one (control condition), we invited participants to tell proverbs to celebrities' faces in order to decide, on a subsequent recognition test, whether they previously told that proverb to that celebrity or not. On the second condition (experimental introspection condition), the same procedures were repeated. However, after telling the proverbs, we invited participants to introspect about what the destination might believe about the proverbs (e.g., "What do you think that the celebrities would think about the proverbs?"). Group comparisons demonstrated better destination memory after the introspection than when no introspection was implemented in control participants, but there were no significant differences between the two conditions in patients with TBI. However, analyses of individual profiles demonstrated that more than half (n = 13) of the patients with TBI demonstrated better destination memory after introspection. While these results demonstrate a beneficial effect of introspection on destination memory for some cases of patients with TBI, more research is needed to reveal how introspection may influence patients' memory in social interactions.
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Affiliation(s)
- Mohamad El Haj
- Institut Universitaire de France, F-75005 Paris, France
- CHU Nantes, Clinical Gerontology Department, Bd Jacques Monod, F-44093 Nantes, France
- LPPL-Laboratoire de Psychologie des Pays de la Loire, Faculté de Psychologie, Université de Nantes, Chemin de la Censive du Tertre, BP 81227, CEDEX 03, F-44312 Nantes, France
| | - Ahmed A. Moustafa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD 4229, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa
| | - Philippe Allain
- Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, CEDEX 01, F-49045 Angers, France
- Département de Neurologie, Centre Hospitalier Universitaire d’Angers, F-49000 Angers, France
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Lin CC, Chen HY, Tseng CY, Yang CC. Effect of Acupuncture on Recovery of Consciousness in Patients with Acute Traumatic Brain Injury: A Multi-Institutional Cohort Study. Healthcare (Basel) 2023; 11:2267. [PMID: 37628465 PMCID: PMC10454345 DOI: 10.3390/healthcare11162267] [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: 07/18/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Traumatic brain injury (TBI) causes cognitive dysfunction and long-term impairments. This study aims to examine the effectiveness of acupuncture on the recovery of consciousness in TBI patients. This is a retrospective, multi-institutional cohort study. We enrolled patients with newly diagnosed TBI from 1 January 2007 to 3 August 2021, aged 20 years and older, from the Chang Gung Research Database (CGRD). The outcome was defined based on the difference between the first and last Glasgow Coma Scale (GCS). A total of 2163 TBI patients were analyzed, and 237 (11%) received acupuncture in the treatment period. Generally, the initial GCS was lower in the acupuncture users (11 vs. 14). For the results of our study, a higher proportion of acupuncture patients achieved significant improvement (GCS differences ≥ 3) compared to non-acupuncture users (46.0% vs. 22.4%, p-value < 0.001). The acupuncture users had a 2.11 times higher chance of achieving a significant improvement when considering all assessable covariates (adjusted odds ratio (aOR) 2, 11, 95% confidence interval [CI]: 1.31-3.40; p-value = 0.002). Using 1:1 propensity score matching (PSM), the acupuncture users still had better outcomes than the non-acupuncture users (45.3% vs. 32.9%, p-value = 0.020). In conclusion, this study suggests that acupuncture treatment may be beneficial for TBI patients.
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Affiliation(s)
- Chun-Chieh Lin
- Division of Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33378, Taiwan; (C.-C.L.); (C.-Y.T.)
| | - Hsing-Yu Chen
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 330036, Taiwan;
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33378, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chu-Yao Tseng
- Division of Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33378, Taiwan; (C.-C.L.); (C.-Y.T.)
| | - Chien-Chung Yang
- Division of Acupuncture and Traumatology, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33378, Taiwan; (C.-C.L.); (C.-Y.T.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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Cherup NP, Robayo LE, Vastano R, Fleming L, Levin BE, Widerström-Noga E. Neuropsychological Function in Traumatic Brain Injury and the Influence of Chronic Pain. Percept Mot Skills 2023; 130:1495-1523. [PMID: 37219529 DOI: 10.1177/00315125231174082] [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: 05/24/2023]
Abstract
Cognitive dysfunction, pain, and psychological morbidity all present unique challenges to those living with traumatic brain injury (TBI). In this study we examined (a) the impact of pain across domains of attention, memory, and executive function, and (b) the relationships between pain and depression, anxiety, and post-traumatic stress disorder (PTSD) in persons with chronic TBI. Our sample included 86 participants with a TBI and chronic pain (n = 26), patients with TBI and no chronic pain (n = 23), and a pain-free control group without TBI (n = 37). Participants visited the laboratory and completed a comprehensive battery of neuropsychological tests as part of a structured interview. Multivariate analysis of covariance using education as a covariate, failed to detect a significant group difference for neuropsychological composite scores of attention, memory, and executive function (p = .165). A follow-up analysis using multiple one-way analysis of variance (ANOVA) was conducted for individual measures of executive function. Post-hoc testing indicated that those in both TBI groups preformed significantly worse on measures of semantic fluency when compared to controls (p < 0.001, ηρ2 = .16). Additionally, multiple ANOVAs indicated that those with TBI and pain scored significantly worse across all psychological assessments (p < .001). We also found significant associations between measures of pain and most psychological symptoms. A follow-up stepwise linear regression among those in the TBI pain group indicated that post concussive complaints, pain severity, and neuropathic pain symptoms differentially contributed to symptoms of depression, anxiety, and PTSD. These findings suggest deficits in verbal fluency among those living with chronic TBI, with results also reinforcing the multidimensional nature of pain and its psychological significance in this population.
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Affiliation(s)
- Nicholas P Cherup
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Linda E Robayo
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Roberta Vastano
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Loriann Fleming
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
| | - Bonnie E Levin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eva Widerström-Noga
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, UHealth/Jackson Memorial, Miami, FL, USA
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
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16
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Cheng A, Tsow R, Schmidt J. Understanding the Barriers of Implementing a Self-Awareness Assessment in Occupational Therapy Practice within a Brain Injury Population: An Exploratory Study. Occup Ther Int 2023; 2023:3933995. [PMID: 37265857 PMCID: PMC10232193 DOI: 10.1155/2023/3933995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
Background Self-awareness is seldom formally assessed by occupational therapists among individuals with traumatic brain injury (TBI). However, impaired self-awareness is prevalent and has a significant impact on rehabilitation outcomes. There is a need to understand clinician perspectives on self-awareness assessments and promote evidence-based practice in clinical settings. Aims (1) Explore how an education session impacts knowledge and use of self-awareness assessments in occupational therapists working with people with TBI; (2) Understand the barriers that occupational therapists experience when assessing self-awareness in clinical practice. Materials and Methods A single-group pre-post session design with an integrated knowledge translation approach was used. Occupational therapists working in neurorehabilitation were recruited from two rehabilitation centres through convenience sampling. Participants completed questionnaires before, after, and three months following an education session about the Self-Awareness of Deficits (SADI) assessment. Results 14 occupational therapists participated in this study. A statistically significant increase in knowledge and confidence in using the SADI was observed both post-session and at 3-month follow-up. Conclusion Targeted and ongoing education promotes confidence and knowledge retention among occupational therapists. Further research should explore strategies to promote behaviour change. Significance. The barriers identified in this study can provide insights for knowledge translation across clinical contexts.
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Affiliation(s)
- Anika Cheng
- Graduate Program in Occupational Therapy, University of British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
| | - Rebecca Tsow
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Canada
| | - Julia Schmidt
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Canada
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Mani R, Asper L, Arunachalam V, Khuu SK. The impact of traumatic brain injury on inhibitory control processes assessed using a delayed antisaccade task. Neurosci Lett 2023; 797:137081. [PMID: 36690058 DOI: 10.1016/j.neulet.2023.137081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
It has been well established that traumatic brain injury (TBI) can affect cognitive function such as attention, working memory and executive functions. In the present study, we further investigated TBI-related changes in cognitive functions by investigating the ability to reorient visuospatial attention using a modified antisaccade task. Performing an antisaccade requires disengaging attention, inhibiting a reflexive saccade, and then engaging attention to execute a voluntary saccade in a direction opposite to a peripheral target. Particularly we quantified the time (latency), and accuracy (directional and disinhibition errors) of 26 TBI and 33 normal participants in making an antisaccade after a variable period of delay (0, 0.0625, 0.125, 0.250, 0.500 or 1.0 s). Changing the delay period allowed to systematically quantify the temporal and spatial characteristics of preparing and initiating an antisaccade and whether this process is affected by TBI. TBI participants took longer (approximately 33-66 ms for variable delays) to generate correct delayed antisaccades and showed increased directional errors (2-11 % for variable delays) and increased disinhibition prosaccade errors (2-6 % for variable delays) compared to controls. However, both groups made similar disinhibition antisaccade errors. These findings indicate that TBI participants required a longer time to process information, and a possible poorer response inhibition and poor spatial information processing due to head injury.
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Affiliation(s)
- Revathy Mani
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
| | - Lisa Asper
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
| | - Valarmathi Arunachalam
- Department of Optometry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
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Bodart A, Invernizzi S, Lefebvre L, Rossignol M. Physiological reactivity at rest and in response to social or emotional stimuli after a traumatic brain injury: A systematic review. Front Psychol 2023; 14:930177. [PMID: 36844281 PMCID: PMC9950643 DOI: 10.3389/fpsyg.2023.930177] [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: 04/27/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023] Open
Abstract
Numerous studies have shown that alterations in physiological reactivity (PR) after traumatic brain injury (TBI) are possibly associated with emotional deficits. We conducted a systematic review of these studies that evaluated PR in adults with moderate-to-severe TBI, either at rest or in response to emotional, stressful, or social stimuli. We focused on the most common measures of physiological response, including heart rate (HR), heart rate variability (HRV), respiratory sinus arrhythmia (RSA), electrodermal activity (EDA), salivary cortisol, facial electromyography (EMG), and blink reflex. Methods A systematic literature search was conducted across six databases (PsycINFO, Psycarticles, SciencDirect, Cochrane Library, PubMed, and Scopus). The search returned 286 articles and 18 studies met the inclusion criteria. Results Discrepancies were observed according to the type of physiological measure. Reduced physiological responses in patients with TBI have been reported in most EDA studies, which were also overrepresented in the review. In terms of facial EMG, patients with TBI appear to exhibit reduced activity of the corrugator muscle and diminished blink reflex, while in most studies, zygomaticus contraction did not show significant differences between TBI and controls. Interestingly, most studies measuring cardiac activity did not find significant differences between TBI and controls. Finally, one study measured salivary cortisol levels and reported no difference between patients with TBI and controls. Conclusion Although disturbed EDA responses were frequently reported in patients with TBI, other measures did not consistently indicate an impairment in PR. These discrepancies could be due to the lesion pattern resulting from TBI, which could affect the PR to aversive stimuli. In addition, methodological differences concerning the measurements and their standardization as well as the characteristics of the patients may also be involved in these discrepancies. We propose methodological recommendations for the use of multiple and simultaneous PR measurements and standardization. Future research should converge toward a common methodology in terms of physiological data analysis to improve inter-study comparisons.
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Affiliation(s)
| | - Sandra Invernizzi
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Laurent Lefebvre
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
| | - Mandy Rossignol
- Cognitive Psychology and Neuropsychology Laboratory, Department of Psychology and Educational Sciences, University of Mons, Mons, Belgium
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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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Minjoz S, Ottaviani E, Phalempin V, Barathon G, Pellissier S, Hot P. Reducing decision-making deficits in patients with brain injury: effect of slow-paced breathing. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-10. [PMID: 36645323 DOI: 10.1080/23279095.2023.2166838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Impairments in decision-making have been reported in brain-damaged (stroke/traumatic brain injury) patients with a wide range of lesion sites. Here, we propose that the performances of patients in complex sequential decision-making (DM) tasks can be explained by their negative affectivity, leading to deliberative processing associated with poor DM performances. We assumed that a slow-paced breathing (SPB) training, by reducing negative affectivity would improve performances in a complex DM task. For 24 days, 34 brain-damaged patients (16 males and 18 females; 12 had a hemorrhagic stroke, 17 with an ischemic stroke and 5 with a TBI), practiced either daily SPB or sham trainings for five min, three times a day. Before and after training, we assessed their vagal tone (electrocardiogram-ECG), affectivity (Positive and Negative Affect Schedule-PANAS) and certainty level (Dimensional Ratings Questionnaire-DRQ) and their performance on the Iowa Gambling Task. All participants showed initial weak performance, which improved only for patients in the SPB training condition. These results suggest that DM disorders in brain-damaged patients can be the consequence of their poor information processing strategy rather than an impairment in their DM abilities. Second, we showed that SPB could be efficient to normalize DM processes in brain injury patients.
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Affiliation(s)
- Séphora Minjoz
- Laboratoire de Psychologie et Neurocognition (LPNC), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS UMR 5105, Grenoble, France
- Laboratoire Interuniversitaire de Psychologie: Personnalité, Cognitions et Changement social (LIP-PC2S), Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
| | - Elena Ottaviani
- Centre de médecine physique et réadaptation, Domaine Saint Alban, St Alban Leysse, France
| | - Valérian Phalempin
- Centre de médecine physique et réadaptation, Domaine Saint Alban, St Alban Leysse, France
| | - Gilles Barathon
- Centre de médecine physique et réadaptation, Domaine Saint Alban, St Alban Leysse, France
| | - Sonia Pellissier
- Laboratoire Interuniversitaire de Psychologie: Personnalité, Cognitions et Changement social (LIP-PC2S), Université Grenoble Alpes, Université Savoie Mont Blanc, Grenoble, France
| | - Pascal Hot
- Laboratoire de Psychologie et Neurocognition (LPNC), Université Grenoble Alpes, Université Savoie Mont Blanc, CNRS UMR 5105, Grenoble, France
- Institut Universitaire de France, Paris, France
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Lewis FD, Horn GJ. Comparison of TBI and CVA outcomes: Durability of gains following post-hospital neurological rehabilitation. NeuroRehabilitation 2023; 52:425-433. [PMID: 36806521 DOI: 10.3233/nre-220261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND With the effectiveness of post-hospital brain injury rehabilitation clearly demonstrated, research focus has shifted to durability of treatment gains over time. OBJECTIVE Study objectives were threefold: (1) examined the stability of outcomes following post-hospital rehabilitation for persons with acquired brain injury, (2) compare differences in short and long-term outcome for TBI and CVA groups, and (3) identify predictors of long-term outcomes. METHODS Subjects (n = 108) were selected from 2,177 neurologically impaired adults with consecutive discharges from 18 post-hospital programs in 12 states from 2011 through 2019. The study sample included TBI, CVA, and Mixed neurological groups. All persons were evaluated using the Mayo Portland Adaptability Inventory -4 Participation Index at four assessment intervals: admission, discharge, and 3 and 12 month follow-up. Additional analyses included repeated measures 2x4 design addressing TBI and CVA by the four measurement periods, and hierarchical multiple regression to identify outcome predictors. RESULTS The total sample demonstrated a reduction in Participation T-scores (indicating less disability) from admission to discharge. Reductions in disability were maintained at the 3 and 12 month follow-up assessments (Greenhouse-Geisser F (2.37) = 76.87, p < 0.001, partial eta2 = 0.418, power to detect = 0.99). The CVA group demonstrated greater disability at each assessment interval, however, those differences were not statistically significant. Significant predictors of outcome at 12 months post-discharge were length of stay in program and type of injury. TBIs with longer length of stay experienced better outcome at 12 months than non-TBIs with shorter length of stays (hierarchical multiple regression adjusted R2 = 0.085, p < 0.05). CONCLUSION Post-hospital residential neurorehabilitation programs provide a return on investment. Gains are realized from admission to discharge, and maintained one year following discharge from rehabilitation.
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Affiliation(s)
- Frank D Lewis
- NeuroRestorative Research Institute, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Gordon J Horn
- NeuroRestorative Research Institute, Florida State University College of Medicine, Tallahassee, FL, USA
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Psychometric Properties of the German Version of the Rivermead Post-Concussion Symptoms Questionnaire in Adolescents after Traumatic Brain Injury and Their Proxies. J Clin Med 2022; 12:jcm12010319. [PMID: 36615119 PMCID: PMC9821190 DOI: 10.3390/jcm12010319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) assesses post-concussion symptoms (PCS) after traumatic brain injury (TBI). The current study examines the applicability of self-report and proxy versions of the German RPQ in adolescents (13-17 years) after TBI. We investigated reliability and validity on the total and scale score level. Construct validity was investigated by correlations with the Post-Concussion Symptoms Inventory (PCSI-SR13), Generalized Anxiety Disorder Scale 7 (GAD-7), and Patient Health Questionnaire 9 (PHQ-9) and by hypothesis testing regarding individuals' characteristics. Intraclass correlation coefficients (ICC) assessed adolescent-proxy agreement. In total, 148 adolescents after TBI and 147 proxies completed the RPQ. Cronbach's α (0.81-0.91) and McDonald's ω (0.84-0.95) indicated good internal consistency. The three-factor structure outperformed the unidimensional model. The RPQ was strongly correlated with the PCSI-SR13 (self-report: r = 0.80; proxy: r = 0.75) and moderately-strongly with GAD-7 and PHQ-9 (self-report: r = 0.36, r = 0.35; proxy: r = 0.53, r = 0.62). Adolescent-proxy agreement was fair (ICC [2,1] = 0.44, CI95% [0.41, 0.47]). Overall, both self-report and proxy assessment forms of the German RPQ are suitable for application in adolescents after TBI. As proxy ratings tend to underestimate PCS, self-reports are preferable for evaluations. Only if a patient is unable to answer, a proxy should be used as a surrogate.
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Leung T, Lim H, Mutlu B, Duff M, Toma C, Turkstra L. Facebook Experiences of Users With Traumatic Brain Injury: A Think-Aloud Study. JMIR Rehabil Assist Technol 2022; 9:e39984. [PMID: 36525296 PMCID: PMC9804090 DOI: 10.2196/39984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A critical gap in our knowledge about social media is whether we can alleviate accessibility barriers and challenges for individuals with traumatic brain injury (TBI), to improve their social participation and health. To do this, we need real-time information about these barriers and challenges, to design appropriate aids. OBJECTIVE The aim of this study was to characterize the ways people with TBI accessed and used social media websites and understand unique challenges they faced. METHODS We invited 8 adults with moderate to severe TBI to log onto their own Facebook page and use it as they regularly would while thinking aloud. Their comments were recorded and transcribed for qualitative analysis. We first analyzed participants' utterances using a priori coding based on a framework proposed by Meshi et al to classify adults' motives for accessing social media. We next used an open coding method to understand the challenges that people with TBI faced while using Facebook. In other words, we analyzed participants' needs for using Facebook and then identified Facebook features that made it challenging for them to meet those needs. RESULTS Participants used all categories of codes in the framework by Meshi et al and provided detailed feedback about the Facebook user interface. A priori coding revealed 2 dimensions that characterized participants' Facebook use: whether they were active or passive about posting and self-disclosure on Facebook and their familiarity and fluency in using Facebook. The open coding analysis revealed 6 types of challenges reported by participants with TBI, including difficulty with language production and interpretation, attention and information overload, perceptions of negativity and emotional contagion, insufficient guidance to use Facebook, concerns about web-based scams and frauds, and general accessibility concerns. CONCLUSIONS Results showed that individuals with TBI used Facebook for the same reasons typical adults do, suggesting that it can help increase social communication and reduce isolation and loneliness. Participants also identified barriers, and we propose modifications that could improve access for individuals with brain injury. On the basis of identified functions and challenges, we conclude by proposing design ideas for social media support tools that can promote more active use of social media sites by adults with TBI.
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Affiliation(s)
| | - Hajin Lim
- Department of Communication, Seoul National University, Seoul, Republic of Korea
| | - Bilge Mutlu
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Melissa Duff
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catalina Toma
- Department of Communication Arts, University of Wisconsin-Madison, Madison, WI, United States
| | - Lyn Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Simos NJ, Manolitsi K, Luppi AI, Kagialis A, Antonakakis M, Zervakis M, Antypa D, Kavroulakis E, Maris TG, Vakis A, Stamatakis EA, Papadaki E. Chronic Mild Traumatic Brain Injury: Aberrant Static and Dynamic Connectomic Features Identified Through Machine Learning Model Fusion. Neuroinformatics 2022; 21:427-442. [PMID: 36456762 PMCID: PMC10085953 DOI: 10.1007/s12021-022-09615-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/25/2022] [Accepted: 11/13/2022] [Indexed: 12/04/2022]
Abstract
AbstractTraumatic Brain Injury (TBI) is a frequently occurring condition and approximately 90% of TBI cases are classified as mild (mTBI). However, conventional MRI has limited diagnostic and prognostic value, thus warranting the utilization of additional imaging modalities and analysis procedures. The functional connectomic approach using resting-state functional MRI (rs-fMRI) has shown great potential and promising diagnostic capabilities across multiple clinical scenarios, including mTBI. Additionally, there is increasing recognition of a fundamental role of brain dynamics in healthy and pathological cognition. Here, we undertake an in-depth investigation of mTBI-related connectomic disturbances and their emotional and cognitive correlates. We leveraged machine learning and graph theory to combine static and dynamic functional connectivity (FC) with regional entropy values, achieving classification accuracy up to 75% (77, 74 and 76% precision, sensitivity and specificity, respectively). As compared to healthy controls, the mTBI group displayed hypoconnectivity in the temporal poles, which correlated positively with semantic (r = 0.43, p < 0.008) and phonemic verbal fluency (r = 0.46, p < 0.004), while hypoconnectivity in the right dorsal posterior cingulate correlated positively with depression symptom severity (r = 0.54, p < 0.0006). These results highlight the importance of residual FC in these regions for preserved cognitive and emotional function in mTBI. Conversely, hyperconnectivity was observed in the right precentral and supramarginal gyri, which correlated negatively with semantic verbal fluency (r=-0.47, p < 0.003), indicating a potential ineffective compensatory mechanism. These novel results are promising toward understanding the pathophysiology of mTBI and explaining some of its most lingering emotional and cognitive symptoms.
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Affiliation(s)
- Nicholas J. Simos
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology–Hellas, 70013 Heraklion, Greece
| | - Katina Manolitsi
- Department of Neurosurgery, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
- Department of Psychiatry, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Andrea I. Luppi
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, CB2 0SP Cambridge, UK
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, CB2 0SP Cambridge, UK
| | - Antonios Kagialis
- Department of Psychiatry, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Marios Antonakakis
- Digital Image and Signal Processing Laboratory, School of Electrical and Computer Engineering, Technical University of Crete, Chania, Greece
| | - Michalis Zervakis
- Digital Image and Signal Processing Laboratory, School of Electrical and Computer Engineering, Technical University of Crete, Chania, Greece
| | - Despina Antypa
- Department of Psychiatry, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Eleftherios Kavroulakis
- Department of Radiology, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Thomas G. Maris
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology–Hellas, 70013 Heraklion, Greece
- Department of Radiology, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Antonios Vakis
- Department of Neurosurgery, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Emmanuel A. Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, CB2 0SP Cambridge, UK
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, CB2 0SP Cambridge, UK
| | - Efrosini Papadaki
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology–Hellas, 70013 Heraklion, Greece
- Department of Radiology, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
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Steward KA, Silva MA, Maduri P, Tang X, Wittine L, Dams-O'Connor K, Nakase-Richardson R. Obstructive sleep apnea is associated with worse cognitive outcomes in acute moderate-to-severe traumatic brain injury: A TBI Model Systems study. Sleep Med 2022; 100:454-461. [PMID: 36252414 DOI: 10.1016/j.sleep.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine the relationship between polysomnography-classified obstructive sleep apnea (OSA) severity and cognitive performance in acute moderate-to-severe traumatic brain injury (TBI). METHOD This was a cross-sectional, secondary analysis leveraging data from a clinical trial (NCT03033901) and TBI Model Systems. Sixty participants (mean age = 50 ± 18y, 72% male, 67% white) with moderate-to-severe TBI from five civilian rehabilitation hospitals were assessed at one-month post-injury. Participants underwent Level 1 polysomnography. OSA severity was classified as mild, moderate, and severe using the Apnea-Hypopnea Index (AHI). Associations between OSA metrics of hypoxemia (nadir and total time spent below 90%) and AHI with cognition were examined. Cognition was assessed with the Brief Test of Adult Cognition by Telephone (BTACT), which is comprised of six subtests assessing verbal memory, attention/working memory, processing speed, language, and executive function. RESULTS Over three-quarters of this acute TBI sample (76.7%) were diagnosed with OSA (no OSA n = 14; mild OSA n = 19; moderate/severe OSA n = 27). After adjustment for age, gender, and education, those with OSA had worse processing speed, working memory, and executive functioning compared to those without OSA. Compared to those with moderate/severe OSA, those with mild OSA had worse working memory and executive function. CONCLUSIONS OSA is highly prevalent during acute stages of TBI recovery, and even in mild cases is related to poorer cognitive performance, particularly in the domains of attention/working memory and executive functioning. Our results support the incorporation of OSA diagnostic tools and interventions into routine clinical care in rehabilitation settings.
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Affiliation(s)
- Kayla A Steward
- Mental Health and Behavioral Sciences, James A. Haley Veteran's Hospital, Tampa, FL, USA.
| | - Marc A Silva
- Mental Health and Behavioral Sciences, James A. Haley Veteran's Hospital, Tampa, FL, USA; Department of Internal Medicine, Pulmonary, Critical Care, and Sleep Medicine Division, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Prathusha Maduri
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xinyu Tang
- Tampa VA Research and Education Foundation, Inc., Tampa, FL, USA
| | - Lara Wittine
- AdventHealth Tampa Sleep Center, Tampa, FL, USA; Department of Internal Medicine, James A. Haley Veteran's Hospital, Tampa, FL, USA
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Risa Nakase-Richardson
- Mental Health and Behavioral Sciences, James A. Haley Veteran's Hospital, Tampa, FL, USA; Department of Internal Medicine, Pulmonary, Critical Care, and Sleep Medicine Division, University of South Florida, Tampa, FL, USA; Defense Health Agency TBI Center of Excellence, Tampa, FL, USA
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Prakash SK, Reddy RP, Mathulla AR, Rajeswaran J, Shukla DP. Neuropsychological Profile of Traumatic Brain Injury Patients with Medicolegal Cases: A Pilot Study. INDIAN JOURNAL OF NEUROTRAUMA 2022. [DOI: 10.1055/s-0041-1740943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Introduction Traumatic brain injury (TBI) is a global health problem and is a silent epidemic of the modern times. Studies indicate litigation is a prominent factor that accounts for poor outcome and prolonged recovery from mild TBI. Depression is the most frequently diagnosed psychiatric disorder after TBI. Postconcussion symptoms, litigation, and suboptimal effort could contribute to the neuropsychological functioning of TBI patients medicolegal cases (MLCs). With increase in TBI and medicolegal cases, there is a requirement for comprehensive neuropsychological assessment.
Method The aim of the study was to evaluate the cognitive functions, postconcussion, and depressive symptoms in TBI patients with MLC and without MLCs (non-MLC). Patients were also assessed on electrophysiological parameters. An observational cross-sectional design was adopted, the sample size was 30 TBI patients in total, 15 (MLC) and 15 (non-MLC), and 11 patients from each group for electrophysiological assessment. The patients were in the age range of 18 to 50 years.
Results The MLC group had poor performance compared with the non-MLC group on both neuropsychological and electrophysiological measures. There was evidence of significant difference in verbal working memory, verbal learning, and memory and visuoconstructive ability. In the MLC group, postconcussion and depressive scores were negatively correlated with visuospatial span.
Conclusion Findings from this study indicate differences in the neuropsychological performance and electroencephalographic measures in between MLC and non-MLC groups. The results could be indicative of persistent cognitive problems associated with TBI for patients pursuing litigation. Poor performance could also be attributed to suboptimal level of effort. However, being a preliminary study with a small sample size, the findings need to be treated with caution.
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Affiliation(s)
- Simi K. Prakash
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Rajakumari P. Reddy
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anna R. Mathulla
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhaval P. Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Hauger SL, Borgen IMH, Løvstad M, Lu J, Forslund MV, Kleffelgård I, Andelic N, Røe C. Community-Based Interventions After Acquired Brain Injury-A Systematic Review of Intervention Types and Their Effectiveness. J Head Trauma Rehabil 2022; 37:E355-E369. [PMID: 35125426 DOI: 10.1097/htr.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Comprehensive review of existing types and effectiveness of community-based interventions delivered to adults (mean age 18-65 years) with long-lasting (≥6 months) difficulties following acquired brain injury (ABI). DESIGN Systematic review of controlled intervention studies published until February 2021. MAIN MEASURES Systematic searches in databases (MEDLINE, PsycINFO, Database of Abstracts of Reviews of Effects [Cochrane Library], and Cochrane Central Register of Controlled Trials [Cochrane Library]) and inclusion of English peer-reviewed full-text articles; randomized or controlled community-based intervention studies; sample size of 20 or more participants; and 3 or more intervention sessions. Two reviewers independently extracted data for the synthesis and assessed the methodological quality. Data extraction included study characteristics, demographics of participants, content and dose of intervention, outcome measures, and findings. RESULT The search returned 7386 publications, of which 49 eligible studies were included, revealing a diverse range of community-based interventions and a myriad of outcome measures applied for assessing functional capacities, participation, and quality of life in the chronic phase of ABI. Intervention types encompassed 14 holistic, 23 physical, and 12 specific interventions. A large heterogeneity regarding intervention frequency and intensity was found. Meta-analyses performed on the holistic, physical, and specific interventions did not indicate any significant pooled effects but showed highly variable effects between individuals, both in persons with traumatic and nontraumatic brain injuries. CONCLUSIONS Because of lack of pooled effects within types of community-based interventions, specific evidence-based recommendations within holistic, physical, and specific interventions designed to mitigate long-lasting ABI problems cannot be made. This review highlights the need for future studies to address methodological issues concerning larger sample size, lack of clear description interventions and comparator, missing reports of effects in change scores, need for consistent use of recommended outcome measures, and investigating the wide variety in intervention responsiveness among participants with ABI. Systematic review registration: PROSPERO (CRD42019124949).
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Affiliation(s)
- Solveig Lægreid Hauger
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway (Drs Hauger and Løvstad); Department of Psychology, Faculty of Social Sciences (Drs Hauger and Løvstad and Ms Borgen), Institute of Clinical Medicine, Faculty of Medicine (Dr Røe), and Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society (Dr Andelic), University of Oslo, Norway; Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, USA (Dr Lu); and Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Norway (Ms Borgen and Drs Forslund, Kleffelgård, Andelic, and Røe)
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Giles GM, Radomski MV, Carroll G, Anheluk M, Yunek J. Cognitive Interventions With Occupational Performance as a Primary Outcome for Adults With TBI (June 2013-October 2020). Am J Occup Ther 2022; 76:23923. [PMID: 36166671 DOI: 10.5014/ajot.2022/76s2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on cognitive interventions to improve occupational performance for adults with traumatic brain injury.
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Affiliation(s)
- Gordon Muir Giles
- Gordon Muir Giles, PhD, OTR/L, is Professor, Samuel Merritt University
| | - Mary Vining Radomski
- Mary Vining Radomski, PhD, OTR/L, FAOTA, is Director, Courage Kenny Research, Courage Kenny Research Center/Allina Health
| | - Ginger Carroll
- Ginger Carroll, MS, OT/L, CPPM, Courage Kenny, Research Center/Allina Health
| | - Mattie Anheluk
- Mattie Anheluk, MOT, OTR/L, Courage Kenny, Rehabilitation Institute- Minneapolis/Allina Health
| | - Joe Yunek
- Joe Yunek, MS, OTR/L, Courage Kenny, Rehabilitation Institute- Minneapolis/Allina Health
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Radomski MV, Giles GM, Carroll G, Anheluk M, Yunek J. Cognitive Interventions to Improve a Specific Cognitive Impairment for Adults With TBI (June 2013-October 2020). Am J Occup Ther 2022; 76:23933. [PMID: 36166674 DOI: 10.5014/ajot.2022/76s2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on cognitive interventions to improve a specific cognitive impairment for adults with TBI.
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Affiliation(s)
- Mary Vining Radomski
- Mary Vining Radomski, PhD, OTR/L, FAOTA, is Director, Courage Kenny Research, Courage Kenny Research Center/Allina Health
| | - Gordon Muir Giles
- Gordon Muir Giles, PhD, OTR/L, is Professor, Samuel Merritt University
| | - Ginger Carroll
- Ginger Carroll, MS, OT/L, CPPM, Courage Kenny Research Center/Allina Health
| | - Mattie Anheluk
- Mattie Anheluk, MOT, OTR/L, Courage Kenny Rehabilitation Institute- Minneapolis/Allina Health
| | - Joe Yunek
- Joe Yunek, MS, OTR/L, Courage Kenny Rehabilitation Institute- Minneapolis/Allina Health
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Martínez‐Molina N, Siponkoski S, Särkämö T. Cognitive efficacy and neural mechanisms of music-based neurological rehabilitation for traumatic brain injury. Ann N Y Acad Sci 2022; 1515:20-32. [PMID: 35676218 PMCID: PMC9796942 DOI: 10.1111/nyas.14800] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Traumatic brain injury (TBI) causes lifelong cognitive deficits, most often in executive function (EF). Both musical training and music-based rehabilitation have been shown to enhance EF and neuroplasticity. Thus far, however, there is little evidence for the potential rehabilitative effects of music for TBI. Here, we review the core findings from our recent cross-over randomized controlled trial in which a 10-week music-based neurological rehabilitation (MBNR) protocol was administered to 40 patients with moderate-to-severe TBI. Neuropsychological testing and structural/functional magnetic resonance imaging were collected at three time points (baseline, 3 months, and 6 months); one group received the MBNR between time points 1 and 2, while a second group received it between time points 2 and 3. We found that both general EF and set shifting improved after the intervention, and this effect was maintained long term. Morphometric analyses revealed therapy-induced gray matter volume changes most consistently in the right inferior frontal gyrus, changes that correlated with better outcomes in set shifting. Finally, we found changes in the between- and within-network functional connectivity of large-scale resting-state networks after MBNR, which also correlated with measures of EF. Taken together, the data provide evidence for concluding that MBNR improves EF in TBI; also, the data show that morphometric and resting-state functional connectivity are sensitive markers with which to monitor the neuroplasticity induced by the MBNR intervention.
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Affiliation(s)
- Noelia Martínez‐Molina
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and LogopedicsUniversity of HelsinkiHelsinki FI‐00014Finland,Centre of Excellence in Music, Mind, Body and BrainUniversity of Jyväskylä & University of HelsinkiHelsinkiFinland
| | - Sini‐Tuuli Siponkoski
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and LogopedicsUniversity of HelsinkiHelsinki FI‐00014Finland,Centre of Excellence in Music, Mind, Body and BrainUniversity of Jyväskylä & University of HelsinkiHelsinkiFinland
| | - Teppo Särkämö
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and LogopedicsUniversity of HelsinkiHelsinki FI‐00014Finland,Centre of Excellence in Music, Mind, Body and BrainUniversity of Jyväskylä & University of HelsinkiHelsinkiFinland
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31
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Cheng Y, Zhang Y, Zhang Y, Wu YH, Zhang S. Reliability and validity of the Rowland Universal Dementia Assessment Scale for patients with traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:1160-1166. [PMID: 33321049 DOI: 10.1080/23279095.2020.1856850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective and accurate cognitive assessment scales are essential for guiding cognitive rehabilitation following traumatic brain injury (TBI). The aim of this study was to evaluate the reliability and validity of the Rowland Universal Dementia Assessment Scale (RUDAS) for TBI and to verify the clinical application value. Fifty patients with TBI and 32 matched controls were assessed using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and a newly developed Chinese version of RUDAS. These scales were then compared for internal consistency, inter-rater reliability, test‒retest reliability, content validity, construct validity, and diagnostic efficacy. Among the TBI group, the RUDAS demonstrated acceptable internal consistency (Cronbach's α = 0.733), high inter-rater reliability (intraclass correlation coefficients [ICCs] of 0.910‒0.999), and high test‒retest reliability (total score ICC = 0.938). The correlation coefficients between RUDAS total score and individual subscores were all > 0.5 except for body orientation (r = 0.363), indicating generally good content validity. Total RUDAS scores were moderately correlated with both MMSE total scores (r = 0.701, p < 0.001) and MoCA total scores (r = 0.778, p < 0.001), indicating good construct validity. Receiving operating characteristic curve analysis yielded comparable areas under the curve for diagnostic efficacy (RUDAS, 0.844; MMSE, 0.769; MoCA, 0.824; all p > 0.05). A RUDAS score cutoff of 23.5 distinguished TBI patients from controls with 60% sensitivity and 100% specificity. Therefore, the RUDAS demonstrates both good reliability and validity for evaluating cognitive impairments in TBI patients.
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Affiliation(s)
- Yun Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ye-Huan Wu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Shuang Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
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Khormali M, Heidari S, Ahmadi S, Arab Bafrani M, Baigi V, Sharif-Alhoseini M. N-methyl-D-aspartate receptor antagonists in improving cognitive deficits following traumatic brain injury: a systematic review. Brain Inj 2022; 36:1071-1088. [PMID: 35997315 DOI: 10.1080/02699052.2022.2109749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To review the role of N-methyl-D-aspartate receptor (NMDAR) antagonists in managing post-TBI cognitive deficits. METHODS A search of PubMed, Embase, and Cochrane was conducted on Jan 12, 2021 without publication date or language restriction. RESULTS Forty-seven studies were included, involving 20 (42.6%) randomized controlled trials. Four (8.5%) studies had a low risk of bias (RoB), while 34 (72.3%) had unclear and nine (19.2%) had high RoB. Six NMDAR antagonists had been investigated: amantadine (n = 32), memantine (n = 4), magnesium (n = 4), traxoprodil (n = 3), selfotel (n = 2), and dextromethorphan (n = 2). CONCLUSION Although some benefits were observed, there are still some concerns regarding the efficacy and safety of NMDAR antagonists in improving post-TBI cognitive deficits. Further research is required to examine whether (i) these agents, notably amantadine, could accelerate cognitive improvement and shorten the hospital stay, (ii) these agents affect different cognitive domains/subdomains in the same direction, (iii) an optimal therapeutic time window exists, (iv) a member of this drug class can be proved to be effective without interfering in non-excitotoxic actions of glutamate, (v) they can be more effective as part of combination therapies or in particular subgroups of patients with TBI.
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Affiliation(s)
- Moein Khormali
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sama Heidari
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sana Ahmadi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Arab Bafrani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Kim SH, Gwak DW, Jeong JG, Jung H, Min YS, Kim AR, Jung TD. Effect of computerized cognitive rehabilitation in comparison between young and old age after traumatic brain injury. Medicine (Baltimore) 2022; 101:e29874. [PMID: 35984190 PMCID: PMC9388031 DOI: 10.1097/md.0000000000029874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Cognitive dysfunction reduces patients' quality of life and social participation with traumatic brain injury (TBI). Computerized cognitive rehabilitation is increasingly being used for cognitive therapy in TBI patients. The purpose of this study was to investigate the influence of age on the effect of computerized cognitive rehabilitation in cognitive dysfunction after TBI. MATERIAL AND METHODS A total of 34 patients with cognitive dysfunction after TBI were enrolled. Participants performed 30 sessions of computerized cognitive rehabilitation (Comcog) for 6 weeks. A cognitive evaluation was performed before and after treatment with Mini-Mental State Examination (MMSE) and Computerized Neurophyschologic Test (CNT). RESULTS There were no cognitive tests that differed between the young group and the old group at baseline. However, after computerized cognitive rehabilitation, the young group showed significant improvement compared to the old group in verbal memory, visual memory, attention, and visuo-motor coordination tests. The young group showed improvement in MMSE, verbal and visual memory, and visuo-motor coordination tests after computerized cognitive rehabilitation. In contrast, the old group showed significant improvement only in MMSE and visual learning test, one of the visual memory tests. CONCLUSION Our findings demonstrate that age may be an important factor related to the effect of computer cognitive rehabilitation on cognitive dysfunction after TBI. Methodologically more ordered studies with larger sample sizes are needed in the future.
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Affiliation(s)
- Seong-Hun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dae-Won Gwak
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jae-Gyeong Jeong
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hyunwoo Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ae-Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- * Correspondence: Tae-Du Jung, Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, 807, Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea (e-mail: )
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Lindsey HM, Lazar M, Mercuri G, Rath JF, Bushnik T, Flanagan S, Voelbel GT. The effects of plasticity-based cognitive rehabilitation on resting-state functional connectivity in chronic traumatic brain injury: A pilot study. NeuroRehabilitation 2022; 51:133-150. [DOI: 10.3233/nre-210264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Traumatic brain injury (TBI) often results in chronic impairments to cognitive function, and these may be related to disrupted functional connectivity (FC) of the brain at rest. OBJECTIVE: To investigate changes in default mode network (DMN) FC in adults with chronic TBI following 40 hours of auditory processing speed training. METHODS: Eleven adults with chronic TBI underwent 40-hours of auditory processing speed training over 13-weeks and seven adults with chronic TBI were assigned to a non-intervention control group. For all participants, resting-state FC and cognitive and self-reported function were measured at baseline and at a follow-up visit 13-weeks later. RESULTS: No significant group differences in cognitive function or resting-state FC were observed at baseline. Following training, the intervention group demonstrated objective and subjective improvements on cognitive measures with moderate-to-large effect sizes. Repeated measures ANCOVAs revealed significant (p < 0.001) group×time interactions, suggesting training-related changes in DMN FC, and semipartial correlations demonstrated that these were associated with changes in cognitive functioning. CONCLUSIONS: Changes in the FC between the DMN and other resting-state networks involved in the maintenance and manipulation of internal information, attention, and sensorimotor functioning may be facilitated through consistent participation in plasticity-based auditory processing speed training in adults with chronic TBI.
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Affiliation(s)
- Hannah M. Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
- Department of Psychology, New York University, New York, NY, USA
| | - Mariana Lazar
- Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Giulia Mercuri
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Department of Psychology, New York University, New York, NY, USA
| | - Joseph F. Rath
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Tamara Bushnik
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Steven Flanagan
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Gerald T. Voelbel
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
- Department of Occupational Therapy and Center of Health and Rehabilitation Research, New York University, New York, NY, USA
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35
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Ahonle ZJ, Tucker M, Degeneffe CE, Romero S, Dillahunt-Aspillaga C. Return to School Outcomes among Adults with TBI One Year After Rehabilitation Discharge: A TBIMS Study. Brain Inj 2022; 36:1000-1009. [PMID: 35916683 DOI: 10.1080/02699052.2022.2105952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To examine return to school outcomes 1 year after traumatic brain injury (TBI) rehabilitation discharge. DESIGN Longitudinal observational study using Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) data at 1-year post-TBI. SETTING Inpatient rehabilitation centers using follow-up telephone calls. INDIVIDUALS Individuals (n = 237) enrolled in the TBIMS-NDB since 2001 between the ages of 18 and 59 years who were engaged in postsecondary education (full or part-time) before recorded TBI. MAIN MEASURES Return to school, categorized as in a postsecondary setting at first follow-up (reported hours in school greater than zero at one-year follow-up). RESULTS Using an alpha level of 0.05 binary logistic regression analysis identified four predictive variables. Significant predictors of return to school include being of lower age, possessing a higher level of functioning at discharge, reporting lower ratings of disability at discharge, and being able to use a vehicle independently for transportation. CONCLUSION Pursuit of higher education is a viable means of community reintegration after TBI. Some individuals with TBI face a myriad of barriers and challenges when returning to school. Study findings may facilitate understanding of how TBI affects return to school and community reintegration outcomes.
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Affiliation(s)
- Zaccheus James Ahonle
- Department of Occupational Therapy, College of Public Health & Health Professions, University of Florida, Florida, US.,Veteran Rural Health Resource Center, Gainesville (VRHRC-GNV), Florida, US.,Rehabilitation Counseling Program, Department of Counseling, Educational Psychology & Foundations, Mississippi State University, Starkville, MS, US
| | - Mark Tucker
- Rehabilitation Counseling Program, Department of Administration, Rehabilitation, and Postsecondary Education, San Diego State University, San Diego, California, US
| | - Charles Edmund Degeneffe
- Rehabilitation Counseling Program, Department of Administration, Rehabilitation, and Postsecondary Education, San Diego State University, San Diego, California, US
| | - Sergio Romero
- Department of Occupational Therapy, College of Public Health & Health Professions, University of Florida, Florida, US.,Veteran Rural Health Resource Center, Gainesville (VRHRC-GNV), Florida, US
| | - Christina Dillahunt-Aspillaga
- Rehabilitation & Mental Health Counseling Program, Child & Family Studies, University of South Florida, Tampa, Florida, US
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36
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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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37
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Uiterwijk D, Stargatt R, Crowe SF. Objective Cognitive Outcomes and Subjective Emotional Sequelae in Litigating Adults with a Traumatic Brain Injury: The Impact of Performance and Symptom Validity Measures. Arch Clin Neuropsychol 2022; 37:1662-1687. [PMID: 35704852 DOI: 10.1093/arclin/acac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study examined the relative contribution of performance and symptom validity in litigating adults with traumatic brain injury (TBI), as a function of TBI severity, and examined the relationship between self-reported emotional symptoms and cognitive tests scores while controlling for validity test performance. METHOD Participants underwent neuropsychological assessment between January 2012 and June 2021 in the context of compensation-seeking claims related to a TBI. All participants completed a cognitive test battery, the Personality Assessment Inventory (including symptom validity tests; SVTs), and multiple performance validity tests (PVTs). Data analyses included independent t-tests, one-way ANOVAs, correlation analyses, and hierarchical multiple regression. RESULTS A total of 370 participants were included. Atypical PVT and SVT performance were associated with poorer cognitive test performance and higher emotional symptom report, irrespective of TBI severity. PVTs and SVTs had an additive effect on cognitive test performance for uncomplicated mTBI, but less so for more severe TBI. The relationship between emotional symptoms and cognitive test performance diminished substantially when validity test performance was controlled, and validity test performance had a substantially larger impact than emotional symptoms on cognitive test performance. CONCLUSION Validity test performance has a significant impact on the neuropsychological profiles of people with TBI, irrespective of TBI severity, and plays a significant role in the relationship between emotional symptoms and cognitive test performance. Adequate validity testing should be incorporated into every neuropsychological assessment, and associations between emotional symptoms and cognitive outcomes that do not consider validity testing should be interpreted with extreme caution.
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Affiliation(s)
- Daniel Uiterwijk
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Robyn Stargatt
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Simon F Crowe
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia
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Improving outcomes for care partners of persons with traumatic brain injury: Protocol for a randomized control trial of a just-in-time-adaptive self-management intervention. PLoS One 2022; 17:e0268726. [PMID: 35679283 PMCID: PMC9182304 DOI: 10.1371/journal.pone.0268726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Informal family care partners of persons with traumatic brain injury (TBI) often experience intense stress resulting from their caregiver role. As such, there is a need for low burden, and easy to engage in interventions to improve health-related quality of life (HRQOL) for these care partners. This study is designed to evaluate the effectiveness of a personalized just-in-time adaptive intervention (JITAI) aimed at improving the HRQOL of care partners. Participants are randomized either to a control group, where they wear the Fitbit® and provide daily reports of HRQOL over a six-month (180 day) period (without the personalized feedback), or the JITAI group, where they wear the Fitbit®, provide daily reports of HRQOL and receive personalized self-management pushes for 6 months. 240 participants will be enrolled (n = 120 control group; n = 120 JITAI group). Outcomes are collected at baseline, 1-, 2-, 3-, 4-, 5- & 6-months, as well as 3- and 6-months post intervention. We hypothesize that the care partners who receive the intervention (JITAI group) will show improvements in caregiver strain (primary outcome) and mental health (depression and anxiety) after the 6-month (180 day) home monitoring period. Participant recruitment for this study started in November 2020. Data collection efforts should be completed by spring 2025; results are expected by winter 2025. At the conclusion of this randomized control trial, we will be able to identify care partners at greatest risk for negative physical and mental health outcomes, and will have demonstrated the efficacy of this JITAI intervention to improve HRQOL for these care partners. Trial registration: ClinicalTrial.gov NCT04570930; https://clinicaltrials.gov/ct2/show/NCT04570930.
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Xu P, Huang X, Niu W, Yu D, Zhou M, Wang H. Metabotropic glutamate receptor 5 upregulation of γ-aminobutyric acid transporter 3 expression ameliorates cognitive impairment after traumatic brain injury in mice. Brain Res Bull 2022; 183:104-115. [DOI: 10.1016/j.brainresbull.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022]
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40
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Sihvonen AJ, Siponkoski ST, Martínez-Molina N, Laitinen S, Holma M, Ahlfors M, Kuusela L, Pekkola J, Koskinen S, Särkämö T. Neurological Music Therapy Rebuilds Structural Connectome after Traumatic Brain Injury: Secondary Analysis from a Randomized Controlled Trial. J Clin Med 2022; 11:jcm11082184. [PMID: 35456277 PMCID: PMC9032739 DOI: 10.3390/jcm11082184] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Traumatic brain injury (TBI) is a common and devastating neurological condition, associated often with poor functional outcome and deficits in executive function. Due to the neuropathology of TBI, neuroimaging plays a crucial role in its assessment, and while diffusion MRI has been proposed as a sensitive biomarker, longitudinal studies evaluating treatment-related diffusion MRI changes are scarce. Recent evidence suggests that neurological music therapy can improve executive functions in patients with TBI and that these effects are underpinned by neuroplasticity changes in the brain. However, studies evaluating music therapy induced structural connectome changes in patients with TBI are lacking. Design: Single-blind crossover (AB/BA) randomized controlled trial (NCT01956136). Objective: Here, we report secondary outcomes of the trial and set out to assess the effect of neurological music therapy on structural white matter connectome changes and their association with improved execute function in patients with TBI. Methods: Using an AB/BA design, 25 patients with moderate or severe TBI were randomized to receive a 3-month neurological music therapy intervention either during the first (AB, n = 16) or second (BA, n = 9) half of a 6-month follow-up period. Neuropsychological testing and diffusion MRI scans were performed at baseline and at the 3-month and 6-month stage. Findings: Compared to the control group, the music therapy group increased quantitative anisotropy (QA) in the right dorsal pathways (arcuate fasciculus, superior longitudinal fasciculus) and in the corpus callosum and the right frontal aslant tract, thalamic radiation and corticostriatal tracts. The mean increased QA in this network of results correlated with improved executive function. Conclusions: This study shows that music therapy can induce structural white matter neuroplasticity in the post-TBI brain that underpins improved executive function.
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Affiliation(s)
- Aleksi J. Sihvonen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.-T.S.); (N.M.-M.); (T.S.)
- Centre of Excellence in Music, Mind, Body and Brain, University of Jyväskylä & University of Helsinki, 00014 Helsinki, Finland;
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre and UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia
- Correspondence:
| | - Sini-Tuuli Siponkoski
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.-T.S.); (N.M.-M.); (T.S.)
- Centre of Excellence in Music, Mind, Body and Brain, University of Jyväskylä & University of Helsinki, 00014 Helsinki, Finland;
| | - Noelia Martínez-Molina
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.-T.S.); (N.M.-M.); (T.S.)
- Centre of Excellence in Music, Mind, Body and Brain, University of Jyväskylä & University of Helsinki, 00014 Helsinki, Finland;
| | - Sari Laitinen
- Centre of Excellence in Music, Mind, Body and Brain, University of Jyväskylä & University of Helsinki, 00014 Helsinki, Finland;
- Espoo Hospital, 02740 Espoo, Finland
| | - Milla Holma
- Independent Researcher, 00550 Helsinki, Finland;
| | | | - Linda Kuusela
- Department of Physics, University of Helsinki, 00014 Helsinki, Finland;
- HUS Medical Imaging Center, Department of Radiology, Helsinki Central University Hospital and University of Helsinki, 00014 Helsinki, Finland;
| | - Johanna Pekkola
- HUS Medical Imaging Center, Department of Radiology, Helsinki Central University Hospital and University of Helsinki, 00014 Helsinki, Finland;
| | - Sanna Koskinen
- Clinical Neuropsychology Research Group, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
| | - Teppo Särkämö
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.-T.S.); (N.M.-M.); (T.S.)
- Centre of Excellence in Music, Mind, Body and Brain, University of Jyväskylä & University of Helsinki, 00014 Helsinki, Finland;
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41
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Lequerica AH, Houston M, Chen MH, Arango-Lasprilla JC. Preliminary construct validity of a memory concerns scale derived from a PROMIS® item bank in a spanish-speaking sample. Neuropsychol Rehabil 2022:1-13. [PMID: 35362366 DOI: 10.1080/09602011.2022.2058965] [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: 10/18/2022]
Abstract
This study examined preliminary evidence of construct validity in a stand-alone memory concerns scale constructed from the Patient-Reported Outcomes Measurement Information System (PROMIS®) Cognitive Function item bank. A sample of 396 individuals, ages 18-75 (M = 33.7, SD = 12.7), from Spain and Latin America completed an online survey regarding lifetime exposure to factors associated with neurological compromise. The sample was 69.4% female. Respondents completed 8 items from the PROMIS® Cognitive Function item bank v1.0 dealing with memory concerns (MCS-8) along with the PROMIS® 8-item short form reflecting general cognitive concerns (CCS-8). The MCS-8 had high internal consistency reliability (Cronbach's alpha = 0.90), and represented a factor distinct from general cognitive concerns items on the CCS-8 in confirmatory factor analysis. Analysis of covariance controlling for sex, age, and education, showed that individuals endorsing history of exposure to sources of neurological compromise scored significantly lower T-scores on the MCS-8 than those who did not report any such history, F(1,390) = 6.4, p = 0.012. Older age was significantly associated with greater memory concerns, a relationship with age not observed with the CCS-8. As a stand-alone self-report measure, the MCS-8 appears to measure a construct distinct from general cognitive concerns that may be of interest for further research in clinical populations.
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Affiliation(s)
- Anthony H Lequerica
- Kessler Foundation, East Hanover, NJ, USA.,Rutgers - New Jersey Medical School, Newark, NJ, USA
| | | | - Michelle H Chen
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, NJ, USA.,Robert Wood Johnson Medical School, Rutgers University, NJ, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute. Barakaldo, Bizkaia, Spain.,IKERBASQUE. Basque Foundation for Science, Bilbao, Spain
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42
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Kujawa K, Żurek A, Gorączko A, Zurek G. Application of High-Tech Solution for Memory Assessment in Patients With Disorders of Consciousness. Front Neurol 2022; 13:841095. [PMID: 35432173 PMCID: PMC9008141 DOI: 10.3389/fneur.2022.841095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Testing cognitive function in patients after severe brain damage is a major clinical challenge. In the absence of both verbal and motor communication, tests commonly used to assess cognitive function are completely or partially undoable for disorders of consciousness patients. The study involved 12 patients with varying degrees of impaired consciousness due to brain damage, with no verbal and motor communication. Memory was assessed in study participants using oculography. Memory tasks were presented in four categories. The total percentage of correctly completed tasks obtained across the group was 39.58%. The most difficult tasks included category C.4 with tasks involving working memory. Regardless of the subjects' level of consciousness, there was no statistically significant difference in the percentage of correct responses obtained in subgroups distinguished by CRS-R score. Eye tracking technology can be successfully used in the assessment of cognitive function, particularly when eye movements are the only channel of communication in individuals after brain damage. We suggest that the cognitive functions of people after brain damage should be further analyzed using eye tracking.
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Affiliation(s)
- Katarzyna Kujawa
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
- Neurorehabilitation Clinic, Wrocław, Poland
| | - Alina Żurek
- Institute of Psychology, University of Wroclaw, Wrocław, Poland
| | - Agata Gorączko
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
- Neurorehabilitation Clinic, Wrocław, Poland
| | - Grzegorz Zurek
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
- *Correspondence: Grzegorz Zurek
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43
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Chou Y, Chang C, Remedios SW, Butman JA, Chan L, Pham DL. Automated Classification of Resting-State fMRI ICA Components Using a Deep Siamese Network. Front Neurosci 2022; 16:768634. [PMID: 35368292 PMCID: PMC8971556 DOI: 10.3389/fnins.2022.768634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Manual classification of functional resting state networks (RSNs) derived from Independent Component Analysis (ICA) decomposition can be labor intensive and requires expertise, particularly in large multi-subject analyses. Hence, a fully automatic algorithm that can reliably classify these RSNs is desirable. In this paper, we present a deep learning approach based on a Siamese Network to learn a discriminative feature representation for single-subject ICA component classification. Advantages of this supervised framework are that it requires relatively few training data examples and it does not require the number of ICA components to be specified. In addition, our approach permits one-shot learning, which allows generalization to new classes not seen in the training set with only one example of each new class. The proposed method is shown to out-perform traditional convolutional neural network (CNN) and template matching methods in identifying eleven subject-specific RSNs, achieving 100% accuracy on a holdout data set and over 99% accuracy on an outside data set. We also demonstrate that the method is robust to scan-rescan variation. Finally, we show that the functional connectivity of default mode and salience networks identified by the proposed technique is altered in a group analysis of mild traumatic brain injury (TBI), severe TBI, and healthy subjects.
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Affiliation(s)
- Yiyu Chou
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
- *Correspondence: Yiyu Chou,
| | - Catie Chang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Samuel W. Remedios
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States
| | - John A. Butman
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, United States
| | - Leighton Chan
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
- Rehabilitation Medicine Department at Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Dzung L. Pham
- Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
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44
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Howlett JR, Nelson LD, Stein MB. Mental Health Consequences of Traumatic Brain Injury. Biol Psychiatry 2022; 91:413-420. [PMID: 34893317 PMCID: PMC8849136 DOI: 10.1016/j.biopsych.2021.09.024] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 01/04/2023]
Abstract
Traumatic brain injury (TBI) is associated with a host of psychiatric and neurobehavioral problems. As mortality rates have declined for severe TBI, attention has turned to the cognitive, affective, and behavioral sequelae of injuries across the severity spectrum, which are often more disabling than residual physical effects. Moderate and severe TBI can cause personality changes including impulsivity, severe irritability, affective instability, and apathy. Mild TBI, once considered a largely benign phenomenon, is now known to be associated with a range of affective symptoms, with suicidality, and with worsening or new onset of several psychiatric disorders including posttraumatic stress disorder and major depressive disorder. Repetitive head impacts, often in athletic contexts, are now believed to be associated with a number of emotional and behavioral sequelae. The nature and etiology of mental health manifestations of TBI (including a combination of brain dysfunction and psychological trauma and interrelationships between cognitive, affective, and physical symptoms) are complex and have been a focus of recent epidemiological and mechanistic studies. This paper will review the epidemiology of psychiatric and neurobehavioral problems after TBI in military, civilian, and athletic contexts.
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Affiliation(s)
- Jonathon R Howlett
- VA San Diego Healthcare System, San Diego, La Jolla, California; Department of Psychiatry, University of California San Diego, La Jolla, California.
| | - Lindsay D Nelson
- Department of Neurosurgery & Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Murray B Stein
- VA San Diego Healthcare System, San Diego, La Jolla, California; Department of Psychiatry, University of California San Diego, La Jolla, California; School of Public Health, University of California San Diego, La Jolla, California
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45
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Kumar RG, Ketchum JM, Hammond FM, Novack TA, O'Neil-Pirozzi TM, Silva MA, Dams-O'Connor K. Health and cognition among adults with and without Traumatic Brain Injury: A matched case-control study. Brain Inj 2022; 36:415-423. [PMID: 35143349 DOI: 10.1080/02699052.2022.2034190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate associations between traumatic brain injury (TBI) and presence of health conditions, and to compare associations of health and cognition between TBI cases and controls. METHODS This matched case-control study used data from the TBI Model Systems National Database (TBI cases) and Midlife in the United States II and Refresher studies (controls). 248 TBI cases were age-, sex-, race-, and education-matched without replacement to three controls. Cases and controls were compared on prevalence of 18 self-reported conditions, self-rated health, composite scores from the Brief Test of Adult Cognition by Telephone. RESULTS The following conditions were significantly more prevalent among TBI cases versus controls: anxiety/depression (OR = 3.12, 95% CI: 2.20, 4.43, p < .001), chronic sleeping problems (OR = 2.76, 95% CI: 1.86, 4.10, p < .001), headache/migraine (OR = 2.61, 95% CI: 1.50, 4.54, p = .0007), and stroke (OR = 6.42, 95% CI: 2.93, 14.10, p < .001). The relationship between self-rated health and cognition significantly varied by TBI (pinteraction = 0.002). CONCLUSION Individuals with TBI have greater odds of selected neurobehavioral conditions compared to their demographically similar uninjured peers. Among persons with TBI there was a stronger association between poorer self-rated health and cognition than controls. TBI is increasingly conceptualized as a chronic disease; current findings suggest post-TBI health management requires cognitive supports.
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Affiliation(s)
- Raj G Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York
| | - Jessica M Ketchum
- Research Department, Craig Hospital, Englewood.,Traumatic Brain Injury Model Systems National Data and Statistical Center, Craig Hospital, Englewood
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis.,Rehabilitation Hospital of Indiana,Indianapolis
| | - Thomas A Novack
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham
| | - Therese M O'Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston.,Department of Communication Sciences and Disorders, Northeastern University, Boston
| | - Marc A Silva
- Mental Health and Behavioral Sciences Service, James A. Haley Veterans' Hospital, Tampa.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa.,Department of Psychology, University of South Florida, Tampa.,Defense and Veterans' Brain Injury Center, Tampa
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York
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46
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Effects of childhood trauma in psychopathy and response inhibition. Dev Psychopathol 2022; 35:724-729. [PMID: 35074037 DOI: 10.1017/s0954579421001863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Childhood trauma is linked to impairments in executive function and working memory, thought to underly psychological disorders including depression and posttraumatic stress disorder. Research demonstrates that childhood trauma can partially mediate posttraumatic stress disorder in those with executive function deficits. Despite a link with executive function deficit, psychopathy as a consequence of trauma is yet to be studied in this context. The present study investigates the possibility of a relationship between childhood trauma, psychopathic traits, and response inhibition. Eighty participants were tasked to completed the Childhood Traumatic Events Scale (Pennebaker & Susman, 2013), Levenson’s Self-Report Psychopathy Scale (Levenson et al., 1995), and Flanker task of response inhibition (Eriksen & Eriksen, 1974). Scores of trauma exposure, psychopathic traits, and reaction times in the Flanker task were measured. Regression analysis revealed no significance for trauma exposure in predicting psychopathic traits (p = .201) and response inhibition (p = .183), indicating that childhood trauma does not strongly predict susceptibility to psychopathic traits or response inhibition deficits. These findings form an important basis on which to build a further understanding of the consequences of childhood trauma exposure, specifically in terms of understanding how specific cognitive functions may be influenced and providing a clearer understanding of how psychopathic traits develop.
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47
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Refined Analysis of Chronic White Matter Changes after Traumatic Brain Injury and Repeated Sports-Related Concussions: Of Use in Targeted Rehabilitative Approaches? J Clin Med 2022; 11:jcm11020358. [PMID: 35054052 PMCID: PMC8780504 DOI: 10.3390/jcm11020358] [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: 12/01/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 12/10/2022] Open
Abstract
Traumatic brain injury (TBI) or repeated sport-related concussions (rSRC) may lead to long-term memory impairment. Diffusion tensor imaging (DTI) is helpful to reveal global white matter damage but may underestimate focal abnormalities. We investigated the distribution of post-injury regional white matter changes after TBI and rSRC. Six patients with moderate/severe TBI, and 12 athletes with rSRC were included ≥6 months post-injury, and 10 (age-matched) healthy controls (HC) were analyzed. The Repeatable Battery for the Assessment of Neuropsychological Status was performed at the time of DTI. Major white matter pathways were tracked using q-space diffeomorphic reconstruction and analyzed for global and regional changes with a controlled false discovery rate. TBI patients displayed multiple classic white matter injuries compared with HC (p < 0.01). At the regional white matter analysis, the left frontal aslant tract, anterior thalamic radiation, and the genu of the corpus callosum displayed focal changes in both groups compared with HC but with different trends. Both TBI and rSRC displayed worse memory performance compared with HC (p < 0.05). While global analysis of DTI-based parameters did not reveal common abnormalities in TBI and rSRC, abnormalities to the fronto-thalamic network were observed in both groups using regional analysis of the white matter pathways. These results may be valuable to tailor individualized rehabilitative approaches for post-injury cognitive impairment in both TBI and rSRC patients.
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48
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Nunes I, Silva Nunes MV. The influence of cognitive reserve in the protection of the cognitive status after an acquired brain injury: A systematic review. J Clin Exp Neuropsychol 2022; 43:839-860. [PMID: 35014599 DOI: 10.1080/13803395.2021.2014788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cognitive Reserve (CR) hypothesis was introduced to account for the variability in cognitive performance of patients with similar degrees of brain injury or pathology. The individual variability of CR is modulated by the interaction of innate capacities and exposures throughout life, which can act as protectors against neuropathology's clinical effects. Individuals with higher CR appear to have better cognitive performance after a brain injury. The present review aimed to identify and map the scientific evidence available in literature regarding CR's influence in protecting the cognitive status after an Acquired Brain Injury (ABI). METHOD A systematic review was performed for published studies until October 2020 in PubMed, Scopus, and CINAHL electronic databases. Studies regarding CR's influence in protecting the cognitive status after an ABI were included in this review. The Newcastle-Ottawa Scale was used to assess risk of bias in the included studies. This systematic review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42021236594. RESULTS Twenty-one studies published between 2003 and 2020 were selected and analyzed. The literature analysis showed that CR has a positive effect on cognitive status after an ABI. Various proxies were used to estimate CR, including estimated premorbid IQ, education, occupation attainment, socioeconomic status, leisure activities, bilingualism, and social integration. CR proxies constitute a set of variables that may have a significant influence on cognitive status. Higher CR levels were associated with lower cognitive impairment after an ABI. CONCLUSIONS Although more research is necessary for a complete understanding of CR's impact on cognition, the synthesis of these studies confirmed that there is evidence on the beneficial impact of CR on cognitive status after an ABI. These findings support CR's cognitive status role following an ABI and may provide additional information for prognosis and rehabilitation plans.
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Affiliation(s)
- Inês Nunes
- Health Sciences Institute, Portuguese Catholic University, Lisbon, Portugal.,Centre for Interdisciplinary Research in Health, Lisbon, Portugal
| | - Maria Vânia Silva Nunes
- Health Sciences Institute, Portuguese Catholic University, Lisbon, Portugal.,Centre for Interdisciplinary Research in Health, Lisbon, Portugal
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49
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Cao H, Tan X, Liu Z, Zhao L, Chi L, Li M, Liu C, Li H. The Effect of Adding Transcranial Direct Current Stimulation to Hyperbaric Oxygen Therapy in Patients With Delayed Encephalopathy After Carbon Monoxide Poisoning: A Randomised Controlled Trial. Front Neurol 2021; 12:719765. [PMID: 34925204 PMCID: PMC8671762 DOI: 10.3389/fneur.2021.719765] [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: 06/03/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: To investigate the effect of transcranial direct current stimulation (tDCS) combined with hyperbaric oxygen therapy (HBOT) in patients with delayed encephalopathy after carbon monoxide poisoning (DEACMP). Design: A parallel-group, open-label randomised controlled study. Setting: Hyperbaric Oxygen Therapy Room of the Second Hospital of Hebei Medical University. Subjects: A total of 40 patients were recruited for the current study. Patients were randomly divided into a treatment group and a control group (20 cases/group). Interventions: Control group: conventional, individualised rehabilitation therapy. Treatment group: conventional, individualised rehabilitation therapy and tDCS. Main Measures: cognitive function of patients, the Barthel Index (BI). Results: After treatment, significantly higher MMSE and BI scores, as well as a greater reduction in P300 latency and an increase in P300 amplitude, were observed in the treatment group compared to the control group (MMSE: 13 ± 7 vs. 9 ± 5; P300 latency: 342 ± 29 vs. 363 ± 17 ms; P300 amplitude: 7.0 ± 3.3 vs. 5.1 ± 2.7 μV; all P < 0.05). In both groups, however, MMSE and BI scores, in addition to P300 amplitude, were significantly improved; in contrast, there was a decrease in P300 latency in both groups after treatment compared to before treatment (all P < 0.05). Conclusion: Combined with HBOT, tDCS can help improve cognitive function and ADL in patients with DEACMP. This combination therapy might be a helpful method to enhance the recovery of patients with DEACMP.
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Affiliation(s)
- Huifang Cao
- The Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaona Tan
- Department of Neurological Rehabilitation, Hebei Medical University Affiliated Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Zibo Liu
- The Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Long Zhao
- The Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lin Chi
- The Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Manyu Li
- The Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chunhui Liu
- The Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongling Li
- The Department of Rehabilitation, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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50
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Huckhagel T, Riedel C, Rohde V, Lefering R. Cranial nerve injuries in patients with moderate to severe head trauma - Analysis of 91,196 patients from the TraumaRegister DGU® between 2008 and 2017. Clin Neurol Neurosurg 2021; 212:107089. [PMID: 34902753 DOI: 10.1016/j.clineuro.2021.107089] [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: 09/27/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) constitutes a major cause of trauma-related disability and mortality. The epidemiology and implications of associated cranial nerve injuries (CNI) in moderate to severe TBI are largely unknown. We aimed to determine the incidence of CNI in a large European cohort of TBI patients as well as clinical differences between TBI cases with and without concomitant CNI (CNI vs. control group) by means of a multinational trauma registry. METHODS The TraumaRegister DGU® was evaluated for trauma patients with head injuries ≥ 2 Abbreviated Injury Scale, who had to be treated on intensive care units after emergency admission to European hospitals between 2008 and 2017. CNI and control cases were compared with respect to demographic, clinical, and outcome variables. RESULTS 1.0% (946 of 91,196) of TBI patients presented with additional CNI. On average, CNI patients were younger than control cases (44.3 ± 20.6 vs. 51.8 ± 23.0 years) but did not differ regarding sex distribution (CNI 69.4% males vs. control 69.1%). Traffic accidents were encountered more frequently in CNI cases (52.3% vs. 46.7%; p < 0.001; chi-squared test) and falls more commonly in the control group (45.2% vs. 37.1%; p < 0.001). CNI patients suffered more frequently from concomitant face injuries (28.2% vs. 17.5%; p < 0.001) and skull base fractures (51.0% vs. 23.5%; p < 0.001). Despite similar mean Injury Severity Score (CNI 21.8 ± 11.3; control 21.1 ± 11.7) and Glasgow Coma Scale score (CNI 10.9 ± 4.2, control 11.1 ± 4.4), there was a considerably higher proportion of anisocoria in CNI patients (20.1% vs. 11.2%; p < 0.001). Following primary treatment, 50.8% of CNI and 35.5% of control cases showed moderate to severe disability (Glasgow Outcome Scale score 3-4; p < 0.001). CONCLUSION CNI rarely occur in the context of TBI. When present, they indicate a higher likelihood of functional impairment following primary care and complicating skull base fractures should be suspected.
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Affiliation(s)
- T Huckhagel
- University Medical Center Göttingen, Department of Neuroradiology, Göttingen, Germany; University Medical Center Hamburg, Department of Neurosurgery, Hamburg, Germany.
| | - C Riedel
- University Medical Center Göttingen, Department of Neuroradiology, Göttingen, Germany
| | - V Rohde
- University Medical Center Göttingen, Department of Neurosurgery, Göttingen, Germany
| | - R Lefering
- University of Witten/Herdecke, Institute for Research in Operative Medicine, Cologne, Germany
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