Journal of Head Trauma Rehabilitation最新文献

Objective: Research highlights a potential relationship between traumatic brain injury (TBI) and psychiatric disorders and substance use. However, the relationship between TBI and these conditions post-injury may be underestimated in many traditional research data sources (eg, health insurance claims).

Setting and participants: Nationally representative data (N = 10 320) from the Research and Development Survey (RANDS).

Design: Cross-sectional.

Main measures: Estimate the association between recent (past 12 months) TBI and anxiety, depression, and binge drinking among adults and examine whether this relationship was modified by sex.

Results: An estimated 5.6% of adults reported experiencing a recent TBI. Among males, sustaining a TBI was associated with 1.6 to 2.4 times the prevalence of adverse mental health measures (anxiety [aPR = 1.61, 95% CIs = 1.11-2.34] and depression [aPR = 2.40, 95% CIs = 1.51-3.80]) compared to males without a TBI. Similarly, among females, sustaining a TBI was associated with 2.2 to 2.6 times the prevalence of anxiety (aPR = 2.19, 95% CIs = 1.66-2.90) and depression (aPR = 2.63, 95% CIs = 1.92-3.61). Results for binge drinking did not suggest a strong association with TBI for either sex; however, CIs were wide.

Conclusion: These findings can help inform treatment and management plans for TBI patients, including potential screening and referral for mental health services among individuals who have experienced a TBI.

Objective: To evaluate whether consumer-grade wearable devices (CGWDs) can detect physiological differences between adolescent athletes recovering from sport-related concussion (SRC) versus musculoskeletal (MSK) injury, and to examine whether wearable-derived physiological markers are associated with symptom burden during the acute post-injury phase.

Setting: Outpatient sports medicine clinic at a pediatric academic medical center.

Participants: High school student-athletes aged 14-18 years were eligible if they presented within 10 days of SRC or acute, nonsurgical MSK injury and had internet access and willingness to comply with study procedures. Thirty-eight participants were enrolled; four were excluded due to protocol deviations. The final analytic sample included 34 participants (SRC: n = 17; MSK: n = 17).

Design: Prospective observational cohort study conducted from September 2021 to April 2022. All participants were issued a Fitbit Sense to passively monitor sleep, activity, and heart rate for up to 6 weeks post-injury. No randomization or blinding occurred, as this was an observational study.

Main measures: The primary outcome was group differences in CGWD-derived physiological metrics (sleep patterns and architecture, physical activity, heart rate) across 3 post-enrollment time intervals (Days 1-14, 15-28, 29-42). Secondary outcomes included correlations between physiological data and symptom burden based on the Post-Concussion Symptom Inventory, Second Edition (PCSI-2).

Results: Compared to MSK peers, participants with SRC showed significantly more light sleep, more nocturnal wake time, and lower daily step counts during the first 4 weeks post-injury (P <.0038). No significant differences were observed in REM sleep, deep sleep, or heart rate. In SRC participants, greater nocturnal wake time and lower resting heart rate were modestly associated with higher cognitive symptom ratings; emotional symptoms were modestly associated with step counts. No adverse events occurred.

Conclusions: CGWDs may capture recovery-specific physiological disruptions in adolescent SRC, particularly in sleep and physical activity. These findings support the potential for wearable technology to inform individualized, objective approaches to concussion monitoring in clinical practice.

Objective: Growing evidence suggests cardiovascular dysfunction represents 1 pathway by which recurrent concussion may lead to adverse long-term outcomes, with earlier onset increasing risk. We investigated the interaction of concussion history and age on the prevalence of cardiovascular risk factors (CRF) and the association of CRF with multidomain function across age in former professional football players.

Setting: Survey-data.

Participants: Former National Football League players.

Design: Former players were dichotomized into older (n = 1071; > age 50-years of age) and younger (n = 902; ≤ 50 years of age) age groups. Logistic and linear regression were used to test the interaction of concussion history and age on prevalence of CRFs, and the association of cardiovascular risk factors with functional outcomes across age groups.

Measures: CRFs included the following: hypertension, hyperlipidemia, diabetes, and sleep apnea. Clinical outcomes from the Patient-Reported Outcomes Measurement Information System included Depression, Anxiety, Cognitive Function, and Emotional and Behavioral Dyscontrol. Logistic and linear regression tested the interaction of concussion history and age on prevalence of CRFs, and the association of cardiovascular risk factors with functional outcomes across age groups.

Results: Significant concussion history by age interactions were observed for hypertension and hyperlipidemia, (P's < .001), with greater number of prior concussions being associated with higher rates of diagnoses for younger former athletes only. A greater prevalence of sleep apnea with higher concussion history was observed regardless of age (P < .001). Significant age by hypertension and hyperlipidemia interactions were observed on clinical outcomes, with higher symptom endorsement among those with CRF in younger former players (P's < .001).

Conclusion: Given higher rates of diagnoses at earlier ages, findings support cardiovascular health as representing one pathway by which recurrent concussion may lead to adverse long-term outcomes in former contact sport athletes. A clinical preventative approach including early screening and management of CRF in those with greater history of concussion should be considered.

Background: Traumatic brain injury (TBI) can cause a wide range of impairments, with moderate to severe TBI resulting in more significant disability than mild TBI. Vestibular dysfunction, which can present symptoms of dizziness, vertigo, or imbalance, is common following a TBI but has been less researched in moderate to severe TBIs.

Objective: To examine the prevalence of vestibular dysfunction in individuals with moderate to severe TBI and investigate the vestibular assessments used.

Methods: A scoping review was conducted following PRISMA-ScR guidelines. Two comprehensive searches were performed using PubMed, CINAHL, Embase, and clinical trial registries, with limitations set for the periods January 1, 1990, to November 8, 2023, and November 9, 2023, to March 27, 2025. Two reviewers screened articles by title and abstract. One reviewer performed full-text screening and final article extraction.

Results: An initial search yielded 7472 articles, of which 91 underwent full-text review, and 11 met the inclusion criteria. A second search added 589 articles, from which 7 additional studies were included. In total, 18 studies met all eligibility criteria and were included in the final review. The included studies varied in design, consisting of randomized controlled trials, cohort studies, cross-sectional studies, and retrospective reviews. Vestibular dysfunction was assessed through a range of methods, and varying metrics determined the severity of TBI. Incidence of vestibular impairments ranged between 1% and 80% in those with moderate to severe TBI.

Conclusion: Vestibular dysfunction is prevalent among individuals with moderate-to-severe TBI, although the methods of assessment vary. Future studies should aim to be more consistent in documenting the severity of TBI, the evaluation of vestibular dysfunction, and determining interventions that are most beneficial for this population.

Objective: Youth involved in the legal system have markedly higher exposure to traumatic brain injury (TBI), yet limited research has examined how TBI relates to specific behavioral outcomes in this population. This preregistered study estimated TBI prevalence in detained youth and investigated associations between TBI dimensions (severity, frequency) and aggression form (physical, verbal) and function (reactive, proactive), violent charges, and facility-recorded behavioral infractions.

Setting: Two state-funded juvenile detention centers in the Midwest US.

Participants: 252 youth (80.95% male, ages 10-17) enrolled between 2022 and 2023.

Design: Cross-sectional study of consecutively admitted youth.

Main measures: TBI history was assessed via self-report, with severity indexed by loss of consciousness (LOC) duration (<30 minutes: mild; >30 minutes: moderate/severe). Youth also completed the Proactive and Reactive Aggression Questionnaire and the Buss-Perry Aggression Questionnaire, and facility records provided information on violent charges and behavioral infractions. Group differences were tested using chi-square tests, t tests, Welch's t tests, and Wilcoxon rank-sum tests, with a preregistered family-wise alpha of .01.

Results: TBI prevalence was 42.06%, with 23.41% reporting multiple TBIs. Among those with TBI, 63% reported LOC, and 14 youth (13.21%) were classified as moderate/severe. Youth with any TBI reported significantly higher physical aggression (Cohen d = 0.46, P = .001). Associations with verbal aggression (d = 0.25, P = .08) and reactive aggression (d = 0.29, P = .02) trended in the same direction but did not meet the preregistered threshold, while proactive aggression showed no association (r = 0.01, P = .83). No significant associations were found between TBI and violent legal charges or behavioral infractions.

Conclusions: TBI is common among detained youth and is selectively associated with elevated physical aggression. Routine TBI screening at intake and interventions targeting impulse control and emotion regulation may improve outcomes for this high-risk population.

Objective: To characterize transitions in independent living, productivity, and social relationships over the first 5 years postinjury among adolescents sustaining complicated mild to severe traumatic brain injury (TBI) between ages 16 and 18.

Setting: Community following discharge from inpatient rehabilitation. Participants: 584 individuals ages 16 to 18 in the traumatic brain injury model systems (TBIMS) national database who completed follow-up at 1, 2, and/or 5 years postinjury.

Design: Multicenter longitudinal observational study.

Main measures: Independent living, employment/school/homemaking, having a close friend/confidant, and involvement in a romantic relationship.

Results: Hidden Markov models were used to identify trajectories of participation, with the optimal number of hidden states (groups) selected using the Bayesian information criterion (BIC). Three states/groups were the best fit for the data and were labeled as: At Risk, On Track, and Partially Transitioned. About 57.5% of participants started as Partially Transitioned, 30% started as At Risk, and 12.5% were On Track. Most in the On Track group had a close friend/confidant and were involved in a romantic relationship. Most in the Partially Transitioned group had a close friend/confidant but were not involved in a romantic relationship. Around 16.7% of individuals in the Partially Transitioned group and only 6.5% of the At Risk group transitioned to On Track, and 98.5% of those in the On Track group remained in the same status. Factors associated with transition to the On Track group included female sex and problem alcohol/substance use. However, further analysis showed that the significant effect of problem alcohol/substance use became nonsignificant after accounting for within-person correlation. Conclusions: Many who sustain a TBI in late adolescence transition to independent living and employment/school/homemaking activity over the first 5 years postinjury; however, a subset remain At Risk or Partially Transitioned in major life roles. Rehabilitation services, beyond the acute period, are needed to ensure maximal independence, social relationships, and community participation.

Objective: Mild traumatic brain injury (mTBI) is common in military veterans, with most symptoms fully resolving within weeks but some persisting for months or years after injury. Chronic symptoms are often attributed to aftereffects of the physiological injury, but veterans are also exposed to higher rates of psychological trauma which take place before, during, and after their military service careers. The present study sought to investigate the relationship between psychological trauma across the lifespan and persistence of mTBI symptoms and postinjury quality of life in US military veterans.

Setting and participants: A total of 463 veterans with a history of mTBI (88.1% male, age 18-92 years [mean age 45.7 years]) were recruited from a VA outpatient TBI clinic.

Design and main measures: In this observational study, participants completed the Neurobehavioral Symptom Inventory (NSI) and Quality of Life after Brain Injury Questionnaire (QOLIBRI) as primary outcome measures. The history of mTBI was extracted from existing VA records, and veterans provided accounts of their cumulative lifetime trauma exposure, including trauma measures from their childhood, deployment, and postdeployment periods.

Results: After controlling for demographic and mTBI characteristics, each trauma measure was significantly positively associated with NSI symptom severity (all partial η2 > .033, all P < .004) and significantly negatively associated with QOLIBRI life satisfaction (all partial η2 > .035, all P < .002). There were no significant associations between outcomes and mTBI characteristics after correcting for multiple comparisons. The associations between psychological trauma and mTBI outcomes were observed across most NSI and QOLIBRI symptom domains, including those more often attributed to physiological explanations (eg, NSI somatic, NSI vestibular, and QOLIBRI physical problem scales).

Conclusion: These findings support the inclusion of comprehensive lifetime trauma assessment in chronic mTBI rehabilitation conceptualizations and underscore the potentially prominent role that psychological stressors play in the persistence of mTBI sequelae.

Objectives: To (1) evaluate differences in psychological health outcomes between US female service members and veterans (FSMVs) with and without mild traumatic brain injury (mTBI) history, and (2) examine the associations between psychological health and lifetime mTBI history, time since last mTBI, blast-mTBI history, and combat-mTBI history.

Setting: Ten military and veteran health care study sites nationwide.

Participants: FSMV enrolled in the Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC) study. We used 2:1 propensity score matching to match FSMVs with a prior mTBI (n = 148; age: 40.0 ± 8.7 years; time since last mTBI: 11.6 ± 9.4 years) to those without mTBI history (n = 74) on demographic and health-history confounders.

Design: Prospective, longitudinal study design with current cross-sectional analysis.

Main measures: FSMVs completed thorough health history evaluations and standardized assessments consisting of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL5), Patient Health Questionnaire-9 (PHQ-9), Neurobehavioral Symptom Inventory (NSI), Satisfaction With Life Scale (SWLS), and the Traumatic Brain Injury-Quality of Life (TBI-QoL) anxiety and emotional-behavioral dyscontrol modules.

Results: Compared to the no mTBI group, FSMVs with any lifetime mTBI displayed worse PCL-5, PHQ-9, NSI, and TBI-QoL Anxiety total scores (P ≤ .002), but not SWLS or TBI-QoL emotional-behavioral dyscontrol. Combat mTBI history demonstrated worse PCL-5, SWLS, and TBI-QoL Anxiety total scores (P ≤ .047). Greater SWLS scores were observed for each year since their last mTBI (P = .048). No significant differences for cumulative mTBI history or any blast-mTBI history were observed across outcomes (P ≥ .146).

Conclusions: FSMVs with ≥1 mTBI history reported greater psychological symptoms than those without. Among FSMVs with lifetime mTBI history, combat-mTBI history was associated with worse PTSD, life satisfaction, and anxiety symptoms. Our findings indicate that a single mTBI, notably combat-related, may adversely impact psychological health, but future research is necessary for longitudinal, comprehensive FSMV health understanding across the lifespan post-mTBI.

Background/Study Motivation: Sex work, an occupation or trade involving exchange of sexual services for economic compensation, is a highly gendered profession, with 60% to 80% of sex workers identifying as women. The rate of traumatic brain injury (TBI) among persons who experience intimate partner violence (IPV) in the sex worker population is significantly high. According to global estimates, 80% of female sex workers have experienced IPV, with an estimated 95% reporting TBIs, sustained either by being hit in the head with objects and/or having their heads slammed into objects while on the job. Conversely, only 10% of IPV survivors in general populations report TBIs. Despite the high "occupational risk" of TBI in the sex worker population, research on the intersection of IPV-TBI in this population has been scant, heavily focused on sexually transmitted diseases and law enforcement, rather than the occupational hazard of IPV-induced TBI that these women face on a daily basis. Literature on HIV/AIDS specifically in sex workers is very well represented, but there is a research gap on the risk of TBI in female sex workers, leaving one of the most vulnerable groups to TBI underrepresented in research and intervention. Objectives, Methods, and Design: In this commentary, we discuss the intersection of sex work and TBI using a "globalization" lens. Drawing from the literature, clinical, observational, and epidemiological cases from Africa (Kenya), Asia (Vietnam), North America (the US), and Oceania (New Zealand), we explore the evolving definitions of sex work; discuss the occupational hazards of the profession with an emphasis on TBI; advocate for ways forward through using harm reduction as a framework; and implore the TBI research community to identify women and girls who participate in sex work as a TBI high-risk group, so they can receive appropriate care and attention. After all, sex work is the "World's Oldest Profession."