Relationship between depression, community integration and life satisfaction following mild traumatic brain injury

Purpose: Compared to studies on moderate and severe traumatic brain injury (TBI), less literature exists concerning the consequences of mild traumatic brain injury (mTBI) on community integration and life satisfaction, especially in the early phase of recovery. Moreover, a better understanding of the variables that contribute to community integration and life satisfaction is still needed. The aim of the study was to assess the association of mood, fatigue and post-concussive symptoms with community integration and life satisfaction early following mTBI.Research method: A total of 85 participants aged between 18 and 61 years who sustained mTBI were included. Participants answered web-based questionnaires measuring anxiety and depression symptoms, fatigue, post-concussive symptoms, community integration and life satisfaction in the first three months post mTBI.Results: Post-concussive symptoms, fatigue and anxiety were not associated with community integration or life satisfaction. However, depressive symptoms were negatively associated with community integration and life satisfaction.Conclusions: Among all acute post-concussive symptoms following mTBI, depressive symptoms seem to have strongest relationship with community integration and life satisfaction. Acute psychological intervention targeting these symptoms is strongly recommended.

Prognostic Value of S-100β Protein for Prediction of Post-Concussion Symptoms after a Mild Traumatic Brain Injury: Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to determine the prognostic value of S-100β protein to identify patients with post-concussion symptoms after a mild traumatic brain injury (mTBI). A search strategy was submitted to seven databases from their inception to October 2016. Individual patient data were requested. Cohort studies evaluating the association between S-100β protein level and post-concussion symptoms assessed at least seven days after the mTBI were considered. Outcomes were dichotomized as persistent (≥3 months) or early (≥7 days <3 months). Our search strategy yielded 23,298 citations of which 29 studies including between seven and 223 patients (n = 2505) were included. Post-concussion syndrome (PCS) (16 studies) and neuropsychological symptoms (9 studies) were the most frequently assessed outcomes. The odds of having persistent PCS (odds ratio [OR] 0.62, 95% confidence interval [CI]: 0.34-1.12, p = 0.11, I² 0% [n = five studies]) in patients with an elevated S-100β protein serum level were not significantly different from those of patients with normal values while the odds of having early PCS (OR 1.67, 95% CI: 0.98-2.85, p = 0.06, I² 38% [n = five studies]) were close to statistical significance. Similarly, having an elevated S-100β protein serum level was not associated with the odds of returning to work at six months (OR 2.31, 95% CI: 0.50-10.64, p = 0.28, I² 22% [n = two studies]). Overall risk of bias was considered moderate. Results suggest that the prognostic biomarker S-100β protein has a low clinical value to identify patients at risk of persistent post-concussion symptoms. Variability in injury to S-100ß protein sample time, mTBI populations, and outcomes assessed could potentially explain the lack of association and needs further evaluation.

Global outcome in acute phase of treatment following moderate-to-severe traumatic brain injury from motor vehicle collisions vs assaults

PRIMARY OBJECTIVE

To compare socio-demographic, medical characteristics and acute outcomes between patients with traumatic brain injuries (TBIs) from motor vehicle collision (MVC) or assault in an acute care setting.

RESEARCH DESIGN

This descriptive, comparative retrospective cohort study included 415 patients with moderate and severe TBI secondary to an assault (n¼91) vs a motor vehicle collision (n=324).

METHODS AND PROCEDURES

Outcome measures were length of stay (LOS) in the intensive care unit and in hospital, Extended Glasgow Outcome Scale (GOS-E), FIM® instrument (‘FIM’) and discharge destination.

MAIN OUTCOMES AND RESULTS

Patients with TBI from MVC had a higher percentage of polytrauma, higher injury severity scores, required more orthopaedic surgeries and thoracic drain insertions. Patients with TBI from assault were more often non-Caucasian, young single men, less educated with higher unemployment rates and criminal records, with a history of alcohol and drug abuse and were more often intoxicated on admission. There was no significant group difference in the LOS and FIM ratings, but patients with assault-related TBI were more often discharged home and had a more favourable GOS-E.

CONCLUSION

Variables such as injury severity, age, level of intoxication on admission and presence of surgeries should be considered when determining acute outcome.

Early prediction of language impairment following traumatic brain injury

PRIMARY OBJECTIVE

This study investigated which factors collected early in the acute care setting (age, education, cerebral imaging, Glasgow Coma Scale score) would predict initial impairments of language comprehension and expression in patients with traumatic brain injury (TBI) of all severity.

METHODS AND PROCEDURES

Results of language tests carried out during the patients' stay in an acute tertiary trauma centre were obtained. These tests measured performance in the areas of confrontation naming, auditory comprehension, semantic and letter category naming and comprehension of verbal absurdities. Data for the predictive variables were gathered by retrospective chart review. Stepwise multiple linear regressions were carried out on the predictive variables.

MAIN OUTCOMES AND RESULTS

Education and TBI severity as measured with the GCS score were the most significant factors predicting language deficits in the acute care setting.

CONCLUSIONS

These findings will serve to guide health care professionals in predicting prognosis for cognitive-communication deficits post-TBI and in planning for appropriate resources in speech-language pathology to meet these patients' needs.

Deficits in executive functions and motor coordination in children with frontal lobe epilepsy

Frontal lobe dysfunction in adults has been associated with impairments of planning abilities, working memory, impulse control, attention and certain aspects of motor coordination. However, very few studies have attempted to assess these functions in children suffering from frontal lobe epilepsy. The aim of the present study was to determine whether some or all of the components of the frontal lobe syndrome are present in children with this disorder. For this purpose, a neuropsychological test battery was administered to 32 unresected epileptic children, aged 8-16 years: 16 with frontal lobe epilepsy (FLE), eight with temporal lobe epilepsy (TLE) and eight with generalized epilepsy whose principal manifestations were typical absences (GEA). The performances of the three epileptic groups were further compared to normative data derived from 200 French-speaking, healthy children aged 7-16 years, except for standardized tests for which the norms provided in the manual were used. The three epilepsy groups did not differ with respect to conceptual shift and recency memory. However, the FLE children showed deficits in planning and impulse control. Furthermore, they had significantly more coordination problems and exhibited greater rigidity than the other epilepsy groups on the motor tests. These problems were more marked in younger FLE children (8-12 years). The latter were also more impaired on verbal fluency measures. No differences were observed with respect to gender, localization of the epileptic abnormality (unilateral versus bilateral) or medication (monotherapy versus polytherapy). The findings reveal similarities between the neuropsychological profiles of FLE children and adults with frontal lobe lesions.