Use of smartphones and tablets after acquired brain injury to support cognition

OBJECTIVES

To describe the use of mobile devices after acquired brain injury (ABI), from the perspectives of injured individuals and significant others, and to examine factors associated with mobile device use for cognition.

METHODS

Cross-sectional study with 50 adults with moderate/severe traumatic brain injury or stroke (42% women; mean of 50.7 years old, 4.6 years post-ABI), and 24 significant others. Participants completed questionnaires on mobile technology, cognitive functioning and the impact of technology.

RESULTS

Of 45/50 adults with ABI who owned a smartphone/tablet, 31% reported difficulties in using their device post-injury, 44% had received support, and 46% were interested in further training. Significant others reported motor/visual impairments and the fear of becoming dependent on technology as barriers for mobile device use, and 65% mentioned that their injured relative needed additional support. Mobile device use for cognition was common (64%), predicted in a regression model by lower subjective memory and more positive perception of the psychosocial impacts of technology, and also associated in univariate analyses with younger age, lower executive functioning, and greater use of memory strategies.

CONCLUSION

Using mobile devices for cognition is common post-ABI but remains challenging for a significant proportion. Developing training approaches may help supporting technology use.

Challenges and facilitators in the experience of caregiving for an older adult with traumatic brain injury: A longitudinal qualitative study in the first-year postinjury

PURPOSE

To obtain a better understanding of the factors which complicate or facilitate the adjustment of caregivers after traumatic brain injury (TBI) in older adults.

RESEARCH METHOD

At 4, 8, and 12 months post-TBI (mild to severe), 65 caregivers answered two open-ended questions regarding facilitators and challenges linked to the injury of their loved one. A thematic analysis was performed.

RESULTS

Participants mentioned almost as many facilitators as challenges at each time point. Among the facilitators, we found the following themes: receiving social support, having access to rehabilitation, improvement of the injured loved one's health condition, returning to live at home, having access to home services, feeling useful, effective communication, and having time for oneself. The challenges identified were: health issues in the injured loved one, psychological impact on the caregiver, assuming a new role, relationship strain, and decrease in activities and outings.

CONCLUSIONS

During the first year following TBI in older adults, caregivers were able to identify several facilitators despite the presence of challenging factors, suggesting effective coping and resilience. This knowledge can guide potential caregivers in their adaptation after TBI in an older adult, and we propose a simple tool to support this process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Lack of association between four biomarkers and persistent post-concussion symptoms after a mild traumatic brain injury

Approximately 15 % of individuals who sustained a mild Traumatic Brain Injury (TBI) develop persistent post-concussion symptoms (PPCS). We hypothesized that blood biomarkers drawn in the Emergency Department (ED) could help predict PPCS. The main objective of this project was to measure the association between four biomarkers and PPCS at 90 days post mild TBI. We conducted a prospective cohort study in seven Canadian EDs. Patients aged ≥ 14 years presenting to the ED within 24 h of a mild TBI who were discharged were eligible. Clinical data and blood samples were collected in the ED, and a standardized questionnaire was administered 90 days later to assess the presence of symptoms. The following biomarkers were analyzed: S100B protein, Neuron Specific Enolase (NSE), cleaved-Tau (c-Tau) and Glial Fibrillary Acidic Protein (GFAP). The primary outcome measure was the presence of PPCS at 90 days after trauma. Relative risks and Areas Under the Curve (AUC) were computed. A total of 595 patients were included, and 13.8 % suffered from PPCS at 90 days. The relative risk of PPCS was 0.9 (95 % CI: 0.5-1.8) for S100B ≥ 20 pg/mL, 1.0 (95 % CI: 0.6-1.5) for NSE ≥ 200 pg/mL, 3.4 (95 % CI: 0.5-23.4) for GFAP ≥ 100 pg/mL, and 1.0 (95 % CI: 0.6-1.8) for C-Tau ≥ 1500 pg/mL. AUC were 0.50, 0.50, 0.51 and 0.54, respectively. Among mild TBI patients, S100B protein, NSE, c-Tau or GFAP do not seem to predict PPCS. Future research testing of other biomarkers is needed to determine their usefulness in predicting PPCS.

Subjective and objective burden and psychological distress in care partners of older adults with traumatic brain injury

PURPOSE/OBJECTIVE

In care partners of older persons (65 years and older) having sustained traumatic brain injury (TBI), the objectives were (a) to describe subjective burden (emotional, social, financial, and physical burden), objective burden (new roles and responsibilities), and psychological distress at 4 months postinjury, and (b) to explore the predictors of subjective burden and psychological distress.

RESEARCH METHOD/DESIGN

This is an observational study of care partners of older adults with TBI (n = 46; M_age = 65.2 years, SD = 11.2, 87% female). Participants completed the Zarit Burden Interview, the Hospital Anxiety and Depression Scale, the Brain Injury Complaint Questionnaire (measuring difficulties of the injured older adult perceived by the care partner), and the modified Medical Outcomes Study Social Support Survey.

RESULTS

A majority of care partners (88%) reported at least one form of objective burden (e.g., increased/decreased time spent in certain activities post-TBI), 29% perceived at least mild subjective burden, and 27% reported either significant anxiety or depressive symptoms. Linear regressions indicated that a higher number of difficulties reported regarding the injured person and poorer perceived social support predicted higher subjective burden and psychological distress. A younger age of the care partner also predicted a higher subjective burden.

CONCLUSIONS/IMPLICATIONS

This study provides a better understanding of the potential impacts of TBI in older age for care partners. Future research should examine how to support adequately care partners in their psychological adaptation after TBI in an elderly person. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Access and adherence to the most recent recommendations regarding resumption of activities after a mild traumatic brain injury

OBJECTIVES

1) To examine access and adherence to the Berlin (2016) recommendations for resuming physical and intellectual activities after mild traumatic brain injury (mTBI) (including an exploration of barriers and facilitators). 2) To assess post-mTBI symptoms in relation to recommendation adherence.

METHOD

73 participants who sustained a mTBI completed an online survey with questions about access and adherence to recommendations and validated measures of symptoms.

RESULTS

Almost all participants had received recommendations from a health professional after their mTBI. Two thirds of recommendations reported had at least moderate correspondence with the Berlin (2016) recommendations. The vast majority of participants reported weak or partial adherence to these recommendations and only 15.7% reported complete adherence. Overall, adherence to recommendations explained a significant portion of the variance in the severity and number of unresolved post-mTBI symptoms. The most common barriers were: being in a critical period for school or work, pressure to return to work or school, screen use, and presence of symptoms.

CONCLUSIONS

Sustained efforts are required to disseminate appropriate recommendations after mTBI. Clinicians should support patients in eliminating barriers to recommendation adherence, as greater adherence may facilitate recovery.

Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD, Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial

This study aimed at evaluating the efficacy of an online CBT intervention with limited therapist contact targeting a range of posttraumatic symptoms among evacuees from the 2016 Fort McMurray wildfires. One hundred and thirty-six residents of Fort McMurray who reported either moderate PTSD symptoms (PCL-5 ≥ 23) or mild PTSD symptoms (PCL-5 ≥ 10) with moderate depression (PHQ-9 ≥ 10) or subthreshold insomnia symptoms (ISI ≥ 8) were randomized either to a treatment (n = 69) or a waitlist condition (n = 67). Participants were on average 45 years old, and mostly identified as White (82%) and as women (76%). Primary outcomes were PTSD, depression, and insomnia symptoms. Secondary outcomes were anxiety symptoms and disability. Significant Assessment Time × Treatment Condition interactions were observed on all outcomes, indicating that access to the treatment led to a decrease in posttraumatic stress (F[1,117.04] = 12.128, p = .001; d = .519, 95% CI = .142-.895), depression (F[1,118.29] = 9.978, p = .002; d = .519, 95% CI = .141-.898) insomnia (F[1,117.60] = 4.574, p = .035; d = .512, 95% CI = .132-.892), and anxiety (F[1,119.64] = 5.465, p = .021; d = .421, 95% CI = .044-.797) symptom severity and disability (F[1,111.55] = 7.015, p = .009; d = .582, 95% CI = .200-.963). Larger effect sizes (d = 0.823-1.075) were observed in participants who completed at least half of the treatment. The RESILIENT online treatment platform was successful to provide access to specialized evidence-based mental health care after a disaster.

The effect of an Internet-based cognitive behavioral therapy intervention on social support in disaster evacuees

INTRODUCTION

Both exposure to a natural disaster and psychological symptoms may lead to decreases in social support. Few studies have examined ways to improve social support among victims of natural disasters.

AIMS

The objective of the study was to assess emotional and tangible support following a 12-session Internet-based cognitive behavioral therapy (ICBT) targeting posttraumatic stress (PTS), insomnia, and depression symptoms and to examine the association between posttreatment symptoms and emotional and tangible support.

MATERIALS AND METHODS

One hundred and seventy-eight wildfire evacuees with significant PTS, depression and/or insomnia symptoms were given access to the ICBT. They completed questionnaires at pre- and posttreatment to measure social support and symptom severity.

RESULTS

Results show that completion of the treatment led to an improvement in emotional support. Lower posttreatment PTS and insomnia symptoms were associated with higher posttreatment emotional support.

CONCLUSION

ICBT may contribute to enhance emotional support through symptom improvement and probably more so when social support is address directly in treatment.

Gender Differences in Usage and Subjective Appreciation of an Online Cognitive Behavioral Therapy for Wildfire Evacuees: Descriptive Study

BACKGROUND

Based on the most common psychological difficulties of the evacuees from the 2016 Fort McMurray wildfires in Alberta, Canada, a therapist-guided cognitive behavioral self-treatment was developed. This study aimed to explore how gender influences the usage and subjective appreciation of the RESILIENT online treatment.

METHODS

Our study included 81 English-speaking evacuees with significant posttraumatic symptoms, or with some posttraumatic symptoms accompanied by at least mild depression symptoms or subclinical insomnia, and who logged into the platform at least once. Various usage and subjective appreciation variables were analyzed, including number of completed sessions, number of logins, number of words per session, perceived efforts, perception of usefulness and intention to continue using the different strategies.

RESULTS

No difference was detected in most objective usage indicators. The number of words written in sessions 7 and 10 was significantly greater for women than for men. Regarding subjective appreciation, men had a greater perception of having put strong efforts in the cognitive restructuring strategy, while women reported in a greater proportion that they wanted to continue using physical exercise as a behavioral activation strategy.

CONCLUSIONS

Our study offers a first look into how women and men use online treatments, and what their preferences are.

Post-Concussion Symptoms Rule: Derivation and Validation of a Clinical Decision Rule for Early Prediction of Persistent Symptoms after a Mild Traumatic Brain Injury

Mild traumatic brain injury (mTBI) is a common problem. Depending on diagnostic criteria, 13 to 62% of those patients develop persistent post-concussion symptoms (PPCS). The main objective of this prospective multi-center study is to derive and validate a clinical decision rule (CDR) for the early prediction of PPCS. Patients aged ≥14 years were included if they presented to one of our seven participating emergency departments (EDs) within 24 h of an mTBI. Clinical data were collected in the ED, and symptom evolution was assessed at 7, 30 and 90 days post-injury using the Rivermead Post-Concussion Questionnaire (RPQ). The primary outcome was PPCS at 90 days after mTBI. A predictive model called the Post-Concussion Symptoms Rule (PoCS Rule) was developed using the methodological standards for CDR. Of the 1083 analyzed patients (471 and 612 for the derivation and validation cohorts, respectively), 15.6% had PPCS. The final model included the following factors assessed in the ED: age, sex, history of prior TBI or mental health disorder, headache in ED, cervical sprain and hemorrhage on computed tomography. The 7-day follow-up identified additional risk factors: headaches, sleep disturbance, fatigue, sensitivity to light, and RPQ ≥21. The PoCS Rule had a sensitivity of 91.4% and 89.6%, a specificity of 53.8% and 44.7% and a negative predictive value of 97.2% and 95.8% in the derivation and validation cohorts, respectively. The PoCS Rule will help emergency physicians quickly stratify the risk of PPCS in mTBI patients and better plan post-discharge resources.

Cognitive functioning following traumatic brain injury in older adults: associations with social participation and health-related quality of life

OBJECTIVES

To describe objective and subjective cognitive functioning older adults who sustained TBI at age 65 or over, and to determine whether cognitive functioning is associated with health-related quality of life (HRQoL) and social participation.

METHOD

The sample consisted of 40 individuals with TBI (mean age = 73 years; 65% mild, 35% moderate/severe TBI). On average 15 months post-injury, they completed measures of objective and subjective cognitive functioning (Telephone Interview for Cognitive Status-Modified, Alphaflex, Medical Outcomes Study Cognitive Functioning Scale), HRQoL (SF-12), and social participation (Participation Assessment with Recombined Tools - Objective).

RESULTS

Mean score for objective cognitive functioning was lower than normative values, while mean scores for executive functioning and subjective cognitive functioning were comparable to normative values. There was no relationship between objective and subjective measures. Subjective cognitive functioning and (to a lesser extent) global objective cognitive functioning were significantly associated with mental HRQoL but not with physical HRQoL or social participation.

CONCLUSION

These results underscore the importance of considering both subjective perception and objective performance when assessing and intervening on cognition to promote better mental HRQoL in older adults with TBI.

Trainee Therapists’ Perceptions of a Blended Intervention to Promote Resilience after a Natural Disaster: A Qualitative Case Study

Background: Natural disasters happen in an increased frequency, and telemental health interventions could offer easily accessible help to reduce mental health symptoms experienced by survivors. However, there are very few programs offered to natural disaster survivors, and no research exists on therapists’ experiences with providing blended interventions for natural disaster survivors. Aims: Our qualitative case study aims to describe psychologists’ experiences with an online, therapist-assisted blended intervention for survivors of the Fort McMurray wildfires in Alberta, Canada. Method: The RESILIENT intervention was developed in the frames of a randomized controlled trial to promote resilience after the Fort McMurray wildfires by providing survivors free access to a 12-module, therapist-assisted intervention, aiming to improve post-traumatic stress, insomnia, and depression symptoms. A focus group design was used to collect data from the therapists, and emerging common themes were identified by thematic analysis. Results: Therapists felt they could build strong alliances and communicate emotions and empathy effectively, although the lack of nonverbal cues posed some challenges. The intervention, according to participating therapists, was less suitable for participants in high-stress situations and in case of discrepancy between client expectations and the intervention content. Moreover, the therapists perceived specific interventions as easy-to-use or as more challenging based on their complexity and on the therapist support needed for executing them. Client engagement in the program emerged as an underlying theme that had fundamental impact on alliance, communication, and ultimately, treatment efficiency. Therapist training and supervision was perceived as crucial for the success of the program delivery. Conclusions: Our findings provided several implications for the optimalization of blended interventions for natural disaster survivors from our therapists’ perspective.

Dual-Task Abilities During Activities Representative of Daily Life in Community-Dwelling Stroke Survivors: A Pilot Study

Background

In addition to several physical skills, being able to walk in the community, walking independently and safely in the community requires the ability to divide attention between walking and other tasks performed simultaneously. The aims of the present pilot study were to measure cognitive-locomotor dual-task (DT) abilities during activities representative of daily living in stroke survivors and to compare them with age- and gender-matched healthy individuals.

Methods

To assess DT abilities, all participants walked along a virtual shopping mall corridor and memorized a 5-item shopping list. Two levels of task complexity were used for the walking task (with or without virtual agents to avoid) and the cognitive task to recall a list of items (with or without a modification at mid-course). The assessment was conducted using an omnidirectional platform and a virtual reality (VR) headset. Locomotor and cognitive DT costs (DTC) were calculated as the percent change from single-task (ST) performance. Walking speed and minimal distance between the participant and the virtual agents were used to characterize locomotor performance. Cognitive performance was assessed by the number of correctly recalled items. One-sample Wilcoxon tests were used to determine the presence of DTCs and Mann-Whitney tests were performed to compare DTCs between the 2 groups.

Results

Twelve community-dwelling stroke survivors [60.50 years old (25-75^th percentiles: 53.50–65.75); 5 women; 13.41 months post-stroke (5.34–48.90)] and 12 age- and gender- matched healthy individuals were recruited. Significant cognitive or mutual (cognitive and locomotor) interferences were observed in participants with stroke in all DT conditions, except the simplest (no virtual agents, no modifications to the list). For the control group, significant mutual interferences were only observed during the most complex DT condition. A group difference was detected in cognitive DTCs during the most complex DT condition (virtual agents and list modifications; p = 0.02). Stroke survivors had greater cognitive DTCs than the control group.

Conclusions

Using an ecological perspective contributes to understanding behavior of stroke survivors in daily activities. Virtual scenarios appear to be an interesting avenue for a more comprehensive understanding of DT abilities during activities representative of daily living in stroke survivors. The usability and feasibility of such an approach will have to be studied before considering implementation in rehabilitation settings.

For a structured response to the psychosocial consequences of the restrictive measures imposed by the global COVID-19 health pandemic: the MAVIPAN longitudinal prospective cohort study protocol

INTRODUCTION

The COVID-19 pandemic and associated restrictive measures have caused important disruptions in economies and labour markets, changed the way we work and socialise, forced schools to close and healthcare and social services to reorganise. This unprecedented crisis forces individuals to make considerable efforts to adapt and will have psychological and social consequences, mainly on vulnerable individuals, that will remain once the pandemic is contained and will most likely exacerbate existing social and gender health inequalities. This crisis also puts a toll on the capacity of our healthcare and social services structures to provide timely and adequate care. The MAVIPAN (Ma vie et la pandémie/ My Life and the Pandemic) study aims to document how individuals, families, healthcare workers and health organisations are affected by the pandemic and how they adapt.

METHODS AND ANALYSIS

MAVIPAN is a 5-year longitudinal prospective cohort study launched in April 2020 across the province of Quebec (Canada). Quantitative data will be collected through online questionnaires (4-6 times/year) according to the evolution of the pandemic. Qualitative data will be collected with individual and group interviews and will seek to deepen our understanding of coping strategies. Analysis will be conducted under a mixed-method umbrella, with both sequential and simultaneous analyses of quantitative and qualitative data.

ETHICS AND DISSEMINATION

MAVIPAN aims to support the healthcare and social services system response by providing high-quality, real-time information needed to identify those who are most affected by the pandemic and by guiding public health authorities' decision making regarding intervention and resource allocation to mitigate these impacts. MAVIPAN was approved by the Ethics Committees of the Primary Care and Population Health Research Sector of CIUSSS de la Capitale-Nationale (Committee of record) and of the additional participating institutions.

TRIAL REGISTRATION NUMBER

NCT04575571.

The Experience and Perceived Consequences of the 2016 Fort McMurray Fires and Evacuation

Few studies have examined the scope of the subjective experience during and after a natural disaster. This qualitative study explored the perceptions of persons affected by the wildfires and evacuation of Fort McMurray in 2016. The objectives were to document (1) the experience of the evacuation, and (2) the biopsychosocial consequences of the wildfires as perceived by evacuees from Fort McMurray 3 months and 3 years after evacuation. This study included two data collections, one from 393 evacuees 3 months after evacuation using an online questionnaire, and the other from 31 participants (among those who participated in the 3-month evaluation) interviewed by telephone 3 years after evacuation. Eight themes describing the evacuation experience emerged from the qualitative analysis: the preparation for evacuation, the perceived traumatic nature of the evacuation, problems encountered while on the move, assistance received and provided, vulnerability conditions, presence of physical discomfort, relocation and no problem/no response. Seven categories of negative consequences emerged: material and financial loss, emotional/mental health disorders, cognitive impairments, behavioral changes, spiritual/existential reflections, social alterations, and physical conditions. Four categories of positive consequences emerged: posttraumatic growth, resilience/absence of consequences, altruism and community cohesion. This study showed a wide range of perceived consequences of fires and evacuations by Fort McMurray residents. The results highlight the importance of tailoring responses to the needs of evacuees and providing assistance to victims over a long period of time.

Anxiety symptoms and disorders in the first year after sustaining mild traumatic brain injury

PURPOSE/OBJECTIVE

The goals of the present study were (a) to document the prevalence of anxiety-related disorders and anxiety symptoms at 4, 8, and 12 months postinjury in individuals with mild traumatic brain injury (mTBI) while considering preinjury history of anxiety disorders and (b) to verify whether the presence of anxiety in the first months after mTBI was associated with more symptoms present 1 year after the injury. Research Method/Design: One hundred and twenty participants hospitalized after an accident and having sustained mTBI were assessed at 4, 8, and 12 months postaccident with the Mini-International Neuropsychiatric Interview, the Hospital Anxiety and Depression Scale, and questionnaires assessing fatigue, irritability, perceived stress, cognitive difficulties, depression, insomnia, and pain.

RESULTS

At 4 months, 23.8% of participants presented with at least one anxiety-related disorder compared with 15.2% at 8 months and 11.2% at 12 months. Overall, 32.5% presented with at least one anxiety disorder over the first 12 months post-mTBI. Participants with a history of anxiety (20.5%) were significantly more anxious after their accident. Individuals who were anxious 4 months after the accident presented with more symptoms in different areas 12 months postinjury compared with nonanxious individuals.

CONCLUSIONS/IMPLICATIONS

The present results highlight that anxiety should be evaluated and managed carefully as it appears to be a key factor in the persistence of other mTBI-related symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Données d’utilisation d’un autotraitement guidé en ligne pour promouvoir la résilience après une catastrophe naturelle

Objectifs Malgré l’existence de plusieurs traitements en ligne pour les personnes avec un trouble de stress posttraumatique (TSPT), peu d’études se sont penchées sur les données d’utilisation d’une telle intervention. Étant donné le potentiel de la modalité en ligne à pallier les obstacles limitant l’accès à l’aide psychologique, il importe de documenter les interactions des usagers avec ces outils en lien avec l’amélioration des symptômes ciblés. L’objectif de cette étude est de documenter les données d’utilisation de la plateforme de traitement en ligne RESILIENT par les personnes évacuées des feux de Fort McMurray, Alberta (Canada), et d’examiner leur association avec l’efficacité du traitement sur les symptômes de trouble de stress posttraumatique (TSPT), d’insomnie et de dépression, et l’adhésion au traitement, mesurée par le nombre de modules consultés par les participants.

Méthode Quatre-vingt-dix-sept personnes évacuées des feux de Fort McMurray présentant des symptômes de TSPT, d’insomnie et de dépression sont incluses dans la présente étude. Les participants étaient invités à utiliser la plateforme RESILIENT, un autotraitement en ligne guidé par un thérapeute qui cible les symptômes de TSPT, le sommeil et l’humeur, et comprend 12 modules offrant des stratégies de thérapies cognitives et comportementales (TCC) basées sur les données probantes. Des données d’utilisation objectives (p. ex. nombre de modules consultés) et subjectives (p. ex. niveau d’efforts investis) ont été recueillies.

Résultats Afin de prédire la réduction des symptômes de TSPT, de dépression et d’insomnie, ainsi que le nombre de modules consultés par les participants, des modèles de régressions séquentielles ont été effectués, avec un contrôle statistique pour les symptômes prétraitement, l’âge et le genre. Les modèles finaux ont révélé qu’une réduction des symptômes de TSPT, de dépression et d’insomnie était prédite significativement par le nombre de modules consultés (β = - 0,41 ; - 0,53 ; - 0,49 respectivement, tous p < 0,001) ainsi que par le niveau d’efforts moyen autorapporté au module 7 (mi-parcours) (β = - 0,43 ; p < 0,001 ; β = - 0,38 ; p = 0,005 et β = - 0,36 ; p = 0,007 respectivement). Le nombre de modules consultés, par ailleurs, était prédit significativement par le nombre de mots dans le 4e module (β = 0,34 ; p < 0,001) et dans le 7e module (β = 0,44 ; p < 0,001), ainsi que par le nombre d’entrées dans le journal du sommeil (β = 0,28 ; p < 0,001).

Conclusion Les résultats ont confirmé qu’une plus grande interaction avec la plateforme influence positivement l’efficacité du traitement et qu’une utilisation accrue en début de traitement semble être un bon prédicteur de l’achèvement de celui-ci. Cette étude confirme l’importance de soutenir l’engagement des participants envers le traitement en ligne afin d’optimiser son efficacité.

Influence of concomitant injuries on post-concussion symptoms after a mild traumatic brain injury - a prospective multicentre cohort study

Objectives: To compare post-concussion symptoms (PCS) and return to normal activities between mild Traumatic Brain Injury (mTBI) patients with or without concomitant injuries at 7-and 90 days post-mTBI.Methods: Design: Sub-analysis of a multicentre prospective cohort study.

PARTICIPANTS AND SETTING

patients with mTBI from 7 Canadian Emergency Departments.

PROCEDURE

Research assistants conducted telephone follow-ups using the Rivermead Postconcussion Symptoms Questionnaire (RPQ) at 7-, 30- and 90 days post-mTBI.

MAIN OUTCOME

Presence of PCS (RPQ: ≥3 symptoms) at 90 days.

SECONDARY OUTCOMES

RPQ score ≥21, prevalence of individual RPQ symptoms and patients' return to normal activities, at 7- and 90-days. Adjusted risk ratios (RR) were calculated.Results: 1725 mTBI patients were included and 1055 (61.1%) had concomitant injuries. Patients with concomitant injuries were at higher risk of having ≥3 symptoms on the RPQ (RR:1.26 [95% CI 1.01-1.58]) at 90 days. They were also at higher risk of experiencing specific symptoms (dizziness, fatigue, headaches and taking longer to think) and of non-return to their normal activities (RR:2.11 [95% CI 1.30-3.45]).Conclusion: Patients with concomitant injuries have slightly more PCS and seemed to be at higher risk of non-return to their normal activities 90 days, compared to patients without concomitant injuries.

Barriers and facilitators linked to discharge destination following inpatient rehabilitation after traumatic brain injury in older adults: a qualitative study

PURPOSE

To identify facilitators and barriers associated with returning home for older adults having received inpatient rehabilitation after traumatic brain injury (TBI).

METHODS

A qualitative design was used. Five older patients with TBI and four family caregivers were interviewed and six healthcare professionals participated in a focus group.

RESULTS

Main facilitators to returning home highlighted by all participants were: (1) Patient's adequate health condition and functional status, (2) Access to health and other services at home, (3) Availability of help from a family caregiver. Conversely, if one of these factors was not met, it represented a barrier. Other facilitators identified were (4) Attachment to one's home, (5) Feeling of commitment toward a loved one, (6) Having the possibility of going through a transitional phase, (7) United front between the patient and the family caregiver towards a return home. Additional barriers to returning home included: (8) Incongruent perspectives, and (9) Unclear knowledge about available health and other services at home.

CONCLUSION

The results of this study could be translated into a practical tool to guide patients, families and professionals in the decision about returning home or exploring an alternative option after inpatient rehabilitation for TBI in older adults.IMPLICATIONS FOR REHABILITATIONWhen orienting an older patient home or to an alternative living environment after a traumatic brain injury (TBI), the perspective of rehabilitation professionals can differ from that of patients and caregivers.Professionals tend to emphasize security, whereas patients and caregivers' focus on the well-being associated with home and on the importance of being with their loved one.Integrating the views, values and wishes of older patients with TBI and their caregivers will support a shared decision-making approach for orientation after rehabilitation.

Psychological Symptoms Among Evacuees From the 2016 Fort McMurray Wildfires: A Population-Based Survey One Year Later

Background: The 2016 wildfires in Fort McMurray (Alberta, Canada) led to a massive displacement of 88,000 people and destroyed 2,400 homes. Although no direct human fatality resulted, many individuals feared for their lives or those of their loved ones.

Objectives: (1) To estimate the prevalence of post-traumatic stress, major depressive, insomnia, generalized anxiety, and substance use disorders in the adult population of Fort McMurray 1 year after the evacuation; (2) To identify pre-, peri-, and post-disaster correlates of mental health disorders.

Methods: A phone survey using random digit sampling was used to survey evacuees. A total of 1,510 evacuees (response rate = 40.2%, 55.5% women, mean age = 44.11, SD = 12.69) were interviewed between May 9th and July 28th, 2017. Five validated scales were administered: the PTSD Symptoms Checklist (PCL-5), the Insomnia Severity Index (ISI), the depression and anxiety subscales of the Patient Health Questionnaire (PHQ-9, GAD-7), and the CAGE Substance Abuse Screening Tool.

Results: One year after the wildfires, 38% had a probable diagnosis of either post-traumatic stress, major depressive, insomnia, generalized anxiety, or substance use disorder, or a combination of these. Insomnia disorder was the most common, with an estimated prevalence of 28.5%. Post-traumatic stress, major depressive and generalized anxiety disorders were almost equally prevalent, with ~15% each. The estimated prevalence of substance use disorder was 7.9%. For all five mental health disorders, having a mental health condition prior to the fires was a significant risk factor, as well as having experienced financial stress or strain due to the economic decline already present in Fort McMurray. Five post-disaster consequences were significant predictors of four of the five disorders: decrease in work, decrease in social life, poorer current health status, increase in drug and alcohol use, and higher level of stress experienced since the fires.

Conclusion: One year after the fires, more than one third of the evacuees had clinically significant psychological symptoms, including those of insomnia, post-traumatic stress, depression, anxiety, and substance use. This study helped identify individuals more at risk for mental health issues after a natural disaster and could guide post-disaster psychosocial support strategies.

Impact of the COVID-19 Pandemic on Older Adults: Rapid Review

BACKGROUND

The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults.

OBJECTIVE

This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias.

METHODS

A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework-Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement.

RESULTS

A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted.

CONCLUSIONS

Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers.

Virtual reality-based assessment of cognitive-locomotor interference in healthy young adults

BACKGROUND

A recent literature review emphasized the importance of assessing dual-task (DT) abilities with tasks that are representative of community ambulation. Assessing DT ability in real-life activities using standardized protocols remains difficult. Virtual reality (VR) may represent an interesting alternative enabling the exposure to different scenarios simulating community walking. To better understand dual-task abilities in everyday life activities, the aims of this study were (1) to assess locomotor and cognitive dual-task cost (DTC) during representative daily living activities, using VR, in healthy adults; and 2) to explore the influence of the nature and complexity of locomotor and cognitive tasks on DTC.

METHODS

Fifteen healthy young adults (24.9 ± 2.7 years old, 8 women) were recruited to walk in a virtual 100 m shopping mall corridor, while remembering a 5-item list (DT condition), using an omnidirectional platform and a VR headset. Two levels of difficulty were proposed for the locomotor task (with vs. without virtual agent avoidance) and for the cognitive task (with vs. without items modification). These tasks were also performed in single task (ST) condition. Locomotor and cognitive DTC were measured by comparing performances in ST and DT conditions. Locomotor performance was characterized using walking speed, walking fluidity, and minimal distance between the participant and the virtual agent during avoidance. Cognitive performance was assessed with the number of items correctly recalled. Presence of DTC were determined with one-sample Wilcoxon signed-rank tests. To explore the influence of the tasks' complexity and nature on DTC, a nonparametric two-way repeated measure ANOVA was performed.

RESULTS

No locomotor interference was measured for any of the outcomes. A cognitive DTC of 6.67% was measured (p = .017) while participants performed simultaneously both complex locomotor and cognitive tasks. A significant interaction between locomotor task complexity and cognitive task nature (p = .002) was identified on cognitive DTC.

CONCLUSIONS

In challenging locomotor and cognitive conditions, healthy young adults present DTC in cognitive accuracy, which was influenced by the locomotor task complexity task and the cognitive task nature. A similar VR-based protocol might be used to investigate DT abilities in older adults and individuals with a stroke.

A Portrait of Mental Health Services Utilization and Perceived Barriers to Care in Men and Women Evacuated During the 2016 Fort McMurray Wildfires

This study examines the influence of gender on mental health services utilization and on perceived barriers to treatment one year after the 2016 Fort McMurray wildfires. Data was collected through a phone survey from May to July 2017 (N = 1510). Participants were English-speaking evacuees aged 18 and older. Mental health services utilization and barriers to mental health care were assessed with the Perceived Need for Care questionnaire. Probable diagnoses of posttraumatic stress disorder, depression and insomnia were assessed with validated self-report questionnaires. Multiple logistic regressions confirmed that gender was a significant predictor of services utilization, after controlling for associated sociodemographic variables and presence of probable diagnoses. Women were respectively 1.50, 1.55 and 1.86 times more likely than men to receive information, medication and psychological help. Self-reliance was the most frequently reported reason for not receiving help, and motivational barriers, such as pessimism and stigma, were reported in a higher proportion than structural barriers, including nonresponse and finance. No significant gender differences were found in the types of perceived barriers to services. Among the Fort McMurray fire evacuees, mental health services utilization was similar to other studies on natural disaster victims, and higher in women than in men. Efforts to increase services utilization in natural disaster victims should focus on motivational barriers and offering treatments fostering people's autonomy, such as online treatments.

Performance during dual-task walking in a corridor after mild traumatic brain injury: A potential functional marker to assist return-to-function decisions

Objective: To compare the performance of participants with mTBI and healthy control on locomotor-cognitive dual-tasks in a corridor with limited technology.Design: Prospective study of twenty participants with mTBI (10 women; 22.10 ± 2.97 years; 70.9 ± 22.31 days post-injury), and 20 sex- and age-matched control participants (10 women; 22.55 ± 2.72 years).Methods: Participants performed six different dual-tasks combining locomotor tasks (level-walking, obstacle-crossing, and tandem gait) and cognitive tasks (counting backwards and verbal fluency). Symptoms and neuropsychological performance were also assessed.Results: No differences between groups were found for symptoms and neuropsychological measures. For gait speed, the group effect was not significant, but a significant group X cognitive task interaction was found, revealing a tendency toward slower gait speed in the mTBI group during dual-task conditions. A significantly greater dual-task cost for gait speed was found for the mTBI group. Although no statistically significant differences in cognitive performance were observed during dual-tasks, the mTBI group subjectively reported being significantly less concentrated.Conclusion: The present study revealed that in persons who seem to have well recovered after mTBI, on average 71 days post-injury, alterations in gait are detectable using a simple, "low-tech," corridor-based dual-task walking assessment.

[Usage Data of an Online Multidimensional Treatment to Promote Resilience After a Disaster]

Objectives Despite the existence of several online treatments for people with posttraumatic stress disorder (PTSD), few studies have examined usage data for such interventions. Given the potential of the online modality to alleviate barriers limiting access to psychological help, it is important to document users' interactions with these tools in relation to the improvement of targeted symptoms. The objective of this study is to document usage data of the online treatment platform RESILIENT by people evacuated from the Fort McMurray, Alberta (Canada) fires, and to examine their association with the effectiveness of treatment on symptoms of posttraumatic stress disorder (PTSD), insomnia and depression, and adherence to treatment, as measured by the number of modules accessed by participants. Methods Ninety-seven people evacuated from the Fort McMurray fires with symptoms of PTSD, insomnia and depression were included in this study. Participants were invited to use the RESILIENT platform, an online therapist-assisted self-help treatment program that targets PTSD symptoms, sleep and mood, and includes 12 modules offering evidence-based cognitive-behavioural therapy (CBT) strategies. Both objective (e.g., number of modules accessed) and subjective (e.g., level of effort invested) usage data were collected. Results In order to predict the reduction in PTSD, depression and insomnia symptoms, as well as the number of modules accessed by participants, sequential regression models were conducted, with statistical control for pretreatment symptoms, age and gender. The final models revealed that a reduction in PTSD, depression and insomnia symptoms was significantly predicted by the number of modules accessed (β = -.41; -.53; -.49 respectively, all p <.001) as well as the mean self-reported level of effort at module 7 (midway) (β = -.43; p <.001; β = -.38; p = .005 and β = -.36; p = .007 respectively). The number of modules accessed, on the other hand, was significantly predicted by the number of words in the 4th module (β = .34; p <.001) and 7th module (β = .44; p <.001) and the number of sleep diary entries (β = .28; p <.001). Conclusion These results confirmed that increased interaction with the platform positively influences treatment effectiveness and that increased use at the beginning of treatment appears to be a good predictor of treatment completion. This study confirms the importance of sustaining participants' commitment to online treatment in order to optimize its effectiveness.

Efficacy of cognitive-behavioural therapy interventions on reducing burden for caregivers of older adults with a neurocognitive disorder: a systematic review and meta-analysis

By 2025, 34 million people worldwide will be living with Alzheimer's disease or another form of dementia (i.e., neurocognitive disorders). Symptoms of neurocognitive disorders have functional repercussions on daily activities. People with neurocognitive disorders often rely on a caregiver to alleviate the impact of their symptoms, but this help has consequences for the caregiver. Indeed, caregivers report subjective burden, depressive symptoms, stress, anxiety and a lower quality of life than non-caregivers. Multiple cognitive-behavioral therapy (CBT) trials have been conducted to reduce these symptoms for caregivers. No meta-analysis has been conducted to evaluate the efficacy of this type of intervention on reducing subjective burden. Articles were selected from PsycNet, MEDLINE, AgeLine and ProQuest Dissertation and Theses for the period from 2000 to 2017. Article selection, data extraction and bias analysis for individual studies were completed by two independent authors who used a consensus procedure when discrepancies occurred. A total of 20 articles were included in the systematic review. Ten studies evaluated the efficacy of CBT in reducing subjective burden, and the meta-analysis suggested a significant reduction in subjective burden following CBT. Additionally, 17 studies evaluated the efficacy in reducing depressive symptoms, and the meta-analysis revealed a significant reduction for these caregivers following CBT. CBT for caregivers of individuals with a neurocognitive disorder had no impact on stress, anxiety, or quality of life.

Caregivers' emotional distress due to neuropsychiatric symptoms of persons with amnestic mild cognitive impairment or Alzheimer's disease

Compared to the literature on Alzheimer's disease (AD), less is known about the emotional distress of caregivers of persons with amnestic Mild Cognitive Impairment (aMCI). This study describes and compares emotional distress due to neuropsychiatric symptoms (NPS) among children and spousal caregivers of aMCI or mild AD care recipients. It also examined the association between the frequency and severity of NPS and caregivers' emotional distress. In total, 108 spouses or children of persons with aMCI or mild AD were administered the Neuropsychiatric Inventory, measuring the frequency/severity of NPS in the patient as well as the associated caregiver's emotional distress. Emotional distress due to each NPS was compared between children and spouses and the relationship between NPS and emotional distress was assessed. There was no significant difference in emotional distress between aMCI and mild AD spousal caregivers for all symptoms, but for children caregivers, emotional distress was significantly higher in the mild AD group than in the aMCI group. Regardless of the caregiver's relationship to the patient or the condition (aMCI vs mild AD) of the latter, there was a positive relationship between the frequency/severity of NPS and caregiver emotional distress. Caregivers of persons with aMCI experienced emotional distress due to the presence of NPS in their significant others at a level that is generally similar to that experienced by caregivers of persons with mild AD. This study highlights the need for interventions to reduce emotional burden by helping caregivers manage NPS in care recipients.

Identifying clinicians' priorities for the implementation of best practices in cognitive rehabilitation post-acquired brain injury

PURPOSE

To identify clinicians' perceptions of current levels of implementation of cognitive rehabilitation best practices, as well as individual and consensual group priorities for implementing cognitive rehabilitation interventions as part of a multi-site integrated knowledge translation initiative.

METHOD

A two-step consensus-building methodology was used, that is the Technique for Research of Information by Animation of a Group of Experts (TRIAGE), including a cross-sectional electronic survey followed by consensual in-person group discussions to identify implementation priorities from a list of evidence-based practices for cognitive rehabilitation following traumatic brain injury and stroke. Thirty-eight professionals from three rehabilitation teams (n = 9, 13 and 16) participated, including neuropsychologists, occupational therapists, speech-language pathologists, educators, clinical coordinators and program managers. Descriptive statistics were used to document the perceived levels of implementation as well as individual and consensual group priorities.

RESULTS

Most of the best practices (81-100%) were perceived as at least partially implemented by a minimum of 50% of the participants but only 20-25% of the practices were considered fully implemented. Findings suggest that current practices are mostly consistent with general cognitive rehabilitation principles suggested in guidelines but that further efforts are needed to support the application of specific cognitive rehabilitation strategies and interventions. Executive function and self-awareness retraining, as well as interventions promoting the generalization of skills, were among the highest implementation priorities. Consensual in-person group discussions, included as part of the TRIAGE process, also helped to define and operationalize these best practices into more specific intervention components according to the teams' needs and priorities.

CONCLUSIONS

TRIAGE consensus-building methodology can be used to engage stakeholders and support clinicians' decision-making regarding the identification of implementation priorities in cognitive rehabilitation post-ABI in order to tailor the implementation process to local needs.IMPLICATIONS FOR REHABILITATIONThe Technique for Research of Information by Animation of a Group of Experts (TRIAGE) can be used to support clinicians' decision-making regarding the identification of implementation priorities in cognitive rehabilitation post-ABI.The combination of individual consultations followed by consensual in-person group discussions, as part of the TRIAGE process, may help clinicians in defining and operationalizing best practices into more specific intervention components to implement.Effective implementation strategies are needed to support the use of specific cognitive rehabilitation interventions in prioritized areas, such as executive function and self-awareness retraining, as well as generalization of skills.Some differences in clinicians' perceived priorities point up the importance of tailoring implementation to local needs and contexts from the early stages in the process.

Alterations in dual-task walking persist two months after mild traumatic brain injury in young adults

Objectives

To compare dual-task performance involving different cognitive-locomotor combinations between healthy controls and participants with sub-acute mild traumatic brain injury (mTBI) and to correlate dual-task performances to history of prior head injuries.

Methods

Eighteen participants having recently sustained mTBI and 15 controls performed nine dual-tasks combining locomotor (level-walking, narrow obstacle, deep obstacle) and cognitive (Stroop task, Verbal fluency, Counting backwards) tasks. Previous history of concussion was also investigated.

Results

Slower gait speeds were observed in the mTBI group compared to controls during both single and dual-tasks. Longer response times to cognitive tasks in the mTBI group further suggested the presence of residual impairments two months following injury. No combination of dual-task was more sensitive. Correlations were observed between history of mTBI and several measures of dual-task performance, underlying the need to further consider the effects of multiple injuries in relation to dual-task walking.

Conclusion

Dual-tasks using simultaneously locomotor and cognitive functions represent an ecological way for clinicians to detect residual, but subtle, alterations post-mTBI. History of previous mTBI needs to be considered as a personal characteristic which may influence dual-task walking performance.

Depression in the First Year after Traumatic Brain Injury

The aims of this study were to document the frequency of major and minor depressive episodes in the first year after traumatic brain injury (TBI), taking into account TBI severity and pre-morbid history of major depression, and to describe trajectories of depressive episodes. Participants were 227 adults who were hospitalized post-TBI (76% male; mean age = 41 years; 50% mild, 33% moderate, and 17% severe TBI). Major and minor depressive episodes were assessed with the Mini International Neuropsychiatric Interview at three time points (4, 8, and 12 months after TBI). Overall, 29% of participants had a major depressive episode in at least one of the three assessments, with fairly stable rates across assessments. Participants with mild TBI were more likely than those with moderate/severe TBI to be diagnosed with major depression, as were individuals with a positive pre-morbid history of depression compared to those without such history. In addition, 13% of participants had a minor depressive episode in at least one of the three assessments. Rates of minor depression significantly decreased from 4 to 8-12 months post-injury. Results also revealed a wide variety of trajectories of depressive episodes across assessments. Of note, 52% of major depression cases still fulfilled diagnostic criteria 4 months later, whereas 38% of minor depression cases deteriorated to major depression at the following assessment. These findings suggest that depression is highly prevalent after TBI, and monitoring of patients with subthreshold depressive symptoms is warranted in order to prevent the development of full-blown major depressive episodes.

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.

MEMO+: Efficacy, Durability and Effect of Cognitive Training and Psychosocial Intervention in Individuals with Mild Cognitive Impairment

BACKGROUND/OBJECTIVES

There is no consensus on the efficacy of cognitive training in persons with mild cognitive impairment (MCI) because of the paucity of well-designed randomized controlled trials. The objective was to assess the effect of memory training on the cognitive functioning of persons with MCI and its durability and to evaluate whether this effect generalizes to daily life and whether positive effects could be obtained from psychosocial intervention.

DESIGN

Single-blind randomized controlled trial.

SETTING

Research centers of the Institut Universitaire de Gériatrie de Montréal and Institut Universitaire en Santé Mentale de Québec.

PARTICIPANTS

Older adults meeting criteria for amnestic MCI (N = 145).

INTERVENTION

Participants were randomized to cognitive training, a psychosocial intervention, or a no-contact control condition. Interventions were provided in small groups in eight 2-hour sessions.

MEASUREMENT

Outcome measures were immediate and delayed composite performance memory scores, psychological health (depression, anxiety, well-being), and generalization effects of the intervention (strategy use in everyday life, difficulties in complex activities of daily living, memory complaints). Testing was administered before training and immediately, 3 months, and 6 months after training.

RESULTS

Participants in the cognitive training condition improved on the delayed composite memory score and on strategy use in everyday life. Improvement was maintained at the 3- and 6-month follow-up assessments. Participants in the psychosocial and no-contact conditions did not show any significant improvement.

CONCLUSION

Cognitive training improves the memory of persons with amnestic MCI. The effect persists over a 6-month period, and learned strategies are used in everyday life. Cognitive training is a valid way to promote cognition in MCI.

Prognostic value of neuron-specific enolase (NSE) for prediction of post-concussion symptoms following a mild traumatic brain injury: a systematic review

BACKGROUND

This systematic review aimed to determine the prognostic value of neuron-specific enolase (NSE) to predict post-concussion symptoms following mild traumatic brain injury (TBI).

METHODS

Seven databases were searched for studies evaluating the association between NSE levels and post-concussion symptoms assessed ≥ 3 months (persistent) or ≥ 7 days < 3 months (early) after mild TBI. Two researchers independently screened studies for inclusion, extracted data and appraised quality using the Quality in Prognostic Studies (QUIPS) tool.

RESULTS

The search strategy yielded a total of 23,298 citations from which 8 cohorts presented in 10 studies were included. Studies included between 45 and 141 patients (total 608 patients). The outcomes most frequently assessed were post-concussion syndrome (PCS, 12 assessments) and neuropsychological performance deficits (10 assessments). No association was found between an elevated NSE serum level and PCS. Only one study reported a statistically significant association between a higher NSE serum level and alteration of at least three cognitive domains at 2 weeks but this association was no longer significant at 6 weeks. Overall, risk of bias of the included studies was considered moderate.

CONCLUSIONS

Early NSE serum level is not a strong independent predictor of post-concussion symptoms following mild TBI.

Characteristics of patients included and enrolled in studies on the prognostic value of serum biomarkers for prediction of postconcussion symptoms following a mild traumatic brain injury: a systematic review

OBJECTIVE

Mild traumatic brain injury (mTBI) has been insufficiently researched, and its definition remains elusive. Investigators are confronted by heterogeneity in patients, mechanism of injury and outcomes. Findings are thus often limited in generalisability and clinical application. Serum protein biomarkers are increasingly assessed to enhance prognostication of outcomes, but their translation into clinical practice has yet to be achieved. A systematic review was performed to describe the adult populations included and enrolled in studies that evaluated the prognostic value of protein biomarkers to predict postconcussion symptoms following an mTBI.

DATA SOURCES

Searches of MEDLINE, Embase, CENTRAL, CINAHL, Web of Science, PsycBITE and PsycINFO up to October 2016.

DATA SELECTION AND EXTRACTION

Two reviewers independently screened for potentially eligible studies, extracted data and assessed the overall quality of evidence by outcome using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

A total of 23 298 citations were obtained from which 166 manuscripts were reviewed. Thirty-six cohort studies (2812 patients) having enrolled between 7 and 311 patients (median 89) fulfilled our inclusion criteria. Most studies excluded patients based on advanced age (n=10 (28%)), neurological disorders (n=20 (56%)), psychiatric disorders (n=17 (47%)), substance abuse disorders (n=13 (36%)) or previous traumatic brain injury (n=10 (28%)). Twenty-one studies (58%) used at least two of these exclusion criteria. The pooled mean age of included patients was 39.3 (SD 4.6) years old (34 studies). The criteria used to define a mTBI were inconsistent. The most frequently reported outcome was postconcussion syndrome using the Rivermead Post-Concussion Symptoms Questionnaire (n=18 (50%)) with follow-ups ranging from 7 days to 5 years after the mTBI.

CONCLUSIONS

Most studies have recruited samples that are not representative and generalisable to the mTBI population. These exclusion criteria limit the potential use and translation of promising serum protein biomarkers to predict postconcussion symptoms.

Autonomie et expérience de la dépendance chez les personnes âgées ayant subi un traumatisme craniocérébral

Le retour à domicile des personnes âgées ayant subi un traumatisme craniocérébral pose la question de leur autonomie. La question porte autant sur leur autonomie fonctionnelle, leur capacité à réaliser les activités de la vie quotidienne, que leur autonomie décisionnelle, leur participation à la prise de décision touchant leur lieu de résidence. Le présent article examine les conditions d’exercice de cette double autonomie et l’expérience de la dépendance chez les personnes ayant subi un traumatisme craniocérébral, dans l’objectif d’améliorer l’accompagnement offert à ces personnes pendant et après la réadaptation. L’analyse repose sur des entretiens avec des personnes âgées et leurs proches.

Executive dysfunction following a mild traumatic brain injury revealed in early adolescence with locomotor-cognitive dual-tasks

OBJECTIVE

To compare gait parameters between children in early adolescence (EA) with and without a mild traumatic brain injury (mTBI) during dual-task walking (DTW).

METHODS

Children in EA with mTBI (n = 14; six girls) were compared to those without (n = 13; five girls) while walking in different combinations of obstacle avoidance and cognitive dual-tasks. Gait speed and fluidity and their related dual-task costs (DTC) were analysed along with foot clearance and proximity to the obstacle.

RESULTS

No group effects were found for gait speed, proximity or clearance, but were found for fluidity DTC, specifically during the dual Stroop task and when crossing the deeper obstacle. There were also group differences for fluidity during the planning of obstacle avoidance for the narrow obstacle combined with the verbal fluency task and the deep obstacle with no cognitive task. Finally, gait fluidity showed group differences across unobstructed dual-task situations.

CONCLUSIONS

Gait fluidity may be a more sensitive variable than gait speed for revealing executive dysfunction following mTBI in EA. Assessing DTW in level walking also seems to show a potential to reveal executive dysfunctions in this age group. These results provide direction for future research on clinical assessment using DTW post-mTBI in adolescents.

Book Review: Insomnia following Traumatic Brain Injury: A Review

Sleep disturbances after a traumatic brain injury (TBI) have received very little scientific attention despite the fact that several studies indicate that they may occur in 30% to 70% of patients. For individuals with TBI, problems falling asleep or maintaining sleep can exacerbate other symptoms such as pain, cognitive deficits, fatigue, or irritability. Sleep disturbances can thus compromise the rehabilitation process and the ability to return to work. This article reviews the evidence on the epidemiology, etiology, and treatment of insomnia in the context of TBI and proposes areas for future research. Prevalence estimates of insomnia complaints in TBI patients are summarized. Potential etiological factors (i.e., lesions to the nervous system, anxiety) and possible consequences of insomnia (i.e., fatigue, cognitive problems) in the context of TBI are discussed. Finally, pharmacological and psychological treatments previously shown effective to treat insomnia in healthy individuals are discussed as valuable treatment options for TBI patients. Increased knowledge about the high prevalence, diagnosis, and potential etiological factors of insomnia following TBI may promote a better identification, evaluation, and treatment of sleeping difficulties in this population.

Fatigue in the first year after traumatic brain injury: course, relationship with injury severity, and correlates

The objectives of this study were to document the evolution of fatigue in the first year after traumatic brain injury (TBI), and to explore correlates of fatigue. Participants were 210 adults who were hospitalised following a TBI. They completed questionnaires 4, 8, and 12 months post-injury, including the Multidimensional Fatigue Inventory (MFI). Participants with severe TBI presented greater mental and physical fatigue, and reduced activity compared to participants with moderate TBI. For all MFI subscales except reduced motivation, the general pattern was a reduction of fatigue levels over time after mild TBI, an increase of fatigue after severe TBI, and stable fatigue after moderate TBI. Fatigue was significantly associated with depression, insomnia, cognitive difficulties, and pain at 4 months; the same variables and work status at 8 months; and depression, insomnia, cognitive difficulties, and work status at 12 months. These findings suggest that injury severity could have an impact on the course of fatigue in the first year post-TBI. Depression, insomnia, and cognitive difficulties remain strong correlates of fatigue, while for pain and work status the association with fatigue evolves over time. This could influence the development of intervention strategies for fatigue, implemented at specific times for each severity subgroup.

Using dual task walking as an aid to assess executive dysfunction ecologically in neurological populations: A narrative review

Within rehabilitation, clinical assessment plays a crucial role in diagnosis, prognostication and making decisions about return to function. The ecological validity of the assessment of executive dysfunction has become a particular focus in neuropsychology and is gaining interest in mobility research and neurological rehabilitation of acquired brain injury or degenerative neurological diseases. In this narrative review, we look at how the task of walking and the inseparable cognitive demands and interference of the surrounding environment are exploited in dual task walking (DTW) paradigms to expose executive dysfunction. While quite a number of studies and reviews have recently focused on the utility of DTW for gait assessment, particularly to assess fall risk, very little consideration has been given to the level of ecological validity required. This paper directly addresses this issue with discussion of evidence and lacunas related to task, personal and technological factors that should be addressed in order to exploit fully DTW paradigms as an ecological assessment tool.

Sleep-wake disturbances after traumatic brain injury

Sleep-wake disturbances are extremely common after a traumatic brain injury (TBI). The most common disturbances are insomnia (difficulties falling or staying asleep), increased sleep need, and excessive daytime sleepiness that can be due to the TBI or other sleep disorders associated with TBI, such as sleep-related breathing disorder or post-traumatic hypersomnia. Sleep-wake disturbances can have a major effect on functional outcomes and on the recovery process after TBI. These negative effects can exacerbate other common sequelae of TBI-such as fatigue, pain, cognitive impairments, and psychological disorders (eg, depression and anxiety). Sleep-wake disturbances associated with TBI warrant treatment. Although evidence specific to patients with TBI is still scarce, cognitive-behavioural therapy and medication could prove helpful to alleviate sleep-wake disturbances in patients with a TBI.

Is cognitive function a concern in independent elderly adults discharged home from the emergency department in Canada after a minor injury?

OBJECTIVES

To describe the cognitive functioning of independent community-dwelling elderly adults visiting the emergency department (ED) for minor injuries and at 3- and 6-month follow-up assessments and to document the occurrence of falls, return to the ED, and hospital visits over time according to cognitive level.

DESIGN

Prospective cohort study.

SETTING

Three Canadian EDs.

PARTICIPANTS

Individuals aged 65 and older who were independent in basic activities of daily living, visiting the ED for minor injuries, and discharged home within 48 hours (N = 320).

MEASUREMENTS

Participants completed the Montreal Cognitive Assessment (MoCA). New falls involving pain and ED or hospital visits were documented at 3 and 6 months.

RESULTS

At baseline, 62.4% of participants scored below the recommended cutoff of 26 on the MoCA, suggesting cognitive dysfunction, and 22.9% scored below a more-stringent cutoff of 21. MoCA scores had improved significantly at 3 and 6 months. Items showing the most improvement were delayed recall and verbal fluency. Persons with MoCA scores of less than 21 reported significantly more new falls and hospital visits 3 to 6 months after injury.

CONCLUSION

Cognition is not optimal in many community-dwelling elderly adults visiting an ED for a minor injury, which may affect their capacity to comprehend, recall, and adhere to medical recommendations after their injury and put them at risk of further negative health events such as falls.

The impact of poor sleep on cognition and activities of daily living after traumatic brain injury: a review

BACKGROUND/AIM

Patients frequently report sleep disruptions or insomnia during their hospital stay, particularly after a traumatic brain injury (TBI). The consequences of these sleep disturbances on everyday activities are not well documented and are therefore not considered in the evaluation of independence in activities of daily living (ADLs). The goal of this narrative review is to explore the consequences of poor sleep quality on cognition and ADLs in the acute and subacute stages of a moderate and severe TBI, when patients are in acute care or inpatient rehabilitation.

METHODS

We will present an overview of normal sleep and its role in cognitive functioning, and then present the findings of studies that have investigated sleep characteristics in hospital settings and the consequences of sleep disturbances on ADLs.

RESULTS

During hospitalisation, TBI patients present severe sleep disturbances such as insomnia and sleep fragmentation, which are probably influenced by both the medical condition and the hospital or rehabilitation environment. Sleep disruption is associated with several cognitive deficits, including attention, memory and executive function impairments. Poor quality and/or insufficient quantity of sleep in acute TBI probably affect general functioning and ADLs calling for these cognitive functions.

CONCLUSIONS AND SIGNIFICANCE

The cognitive impairments present following TBI are probably exacerbated by poor sleep quality and sleep deprivation during hospitalisation, which in turn impact ADLs among this population. Health-care personnel should further consider sleep disturbances among people with TBI and a sleep protocol should be established.