Journal of Head Trauma Rehabilitation最新文献

Objective: Investigate sex-related differences in mild traumatic brain injury (mTBI) risks due to sports among children aged 9 to 10 years and examine whether the benefits of sports participation, specifically in behavioral, neurocognitive, and psychiatric health, differ between boys and girls.

Setting: The Adolescent Brain Cognitive Development study involves 21 sites across the United States. The data were collected through comprehensive evaluations including neuroimaging, cognitive tests, mental health evaluations, family and environmental factors, and genetic data.

Participants: The study enrolled a cohort of 11 878 children ages 9 to 10 from years 2016 to 2018. A total of 11 055 children at baseline were analyzed.

Design: The study is a cross-sectional analysis of the baseline data from an ongoing longitudinal cohort study.

Main measures: Our primary outcome was children's lifetime mTBI (yes/no), with exposure as participation in 23 sports (yes/no). Confounders included age, race, parental income, parental education, internalizing and externalizing behaviors.

Results: Among 11 055 children (5295 girls and 5760 boys) with complete data, 85% (n = 9423) had participated in sports. Among them, the risk of mTBI was higher among boys who played tennis versus girls who played tennis, with an adjusted odds ratio (aOR) = 2.353 (95% confidence interval [CI]: 1.072, 5.606), P = .032; the risk of mTBI was lower among boys who participated in swimming/water polo versus girls who participated in swimming/water polo, aOR = 0.618 (95% CI: 0.399, 0.955), P = .030.

Conclusion: The association between sports participation and mTBI risks differs by sex for certain sports. Compared to girls, boys had a higher mTBI risk in tennis but a lower mTBI risk in swimming/water polo. This indicates that implementing sex-specific strategies to mitigate mTBI risks in sports participation could be beneficial.

Objective: To assess sex differences in behavior and motivation of adolescent athletes with sport-related concussion (SRC) versus controls during a 2-week individualized aerobic exercise intervention.

Setting: Academic center research laboratory.

Participants: Participants were enrolled within 10 days of SRC (n = 32; 15.6 ± 1.4 years, 33% female, 6.18 ± 2.21 days from injury). Twenty-eight control participants (16.0 ± 1.6 years, 33% female) were recruited.

Design: Randomized control trial with a 1:1 block randomization scheme stratified by participant sex.

Main measures: Clinical recovery time as determined by the study physician, heart rate threshold (HRt) on the Buffalo Concussion Treadmill Test, adherence rates (calculated as exercise volume completed/exercise volume prescribed), and behavioral assessments including the perceived competence scale (PCS) and the treatment self-regulation questionnaire (TSRQ).

Results: Females achieved higher initial HRts ( P = .007), ie, the maximum HR during exercise testing. Males and females with a concussion showed minimal differences in motivation and perceived competence. Although it did not reach statistical significance ( P = .058), females in the low-volume group appeared to recover faster than the high-volume group. This trend was not seen in males. Seven (88%) of exercise-intolerant females had to stop an exercise bout early on 1 or more days due to more-than-mild symptom exacerbation versus 3 (17%) of exercise-intolerant males ( P = .002).

Conclusion: Females with a concussion prescribed a high volume of aerobic exercise treatment appeared to take longer to recover than females with a concussion who were prescribed a lower volume, which was not seen in males. Increased training heart rate prescriptions due to higher initial HRts and symptom exacerbation during at-home exercise may have affected female exercise behavior. Although aerobic exercise benefits SRC recovery, this study highlights the need for future research to optimize exercise treatment prescriptions for females after SRC.

Objective: The aim of the study was to characterize the experiences of intimate partner violence (IPV)-related head trauma (HT) among cisgender women.

Setting: Three geographic regions across the United States.

Participants: Seventy-two cisgender women aged 18 to 60 years (mean age = 39.6 years).

Design: In-depth semi-structured interviews.

Main measures: Participants completed a semi-structured interview, which was audio-recorded to determine the number and mechanisms of IPV-HT injuries experienced over their lifetime. Quotes from interview transcriptions were used to illustrate how participants describe their IPV-HT episodes.

Results: A total of 69/72 cisgender women reported at least 1 injury episode that involved IPV-HT. Participants reported between 1 and 9 injury episodes that involved HT during their lifetimes. Participants reported a total of 240 injury episodes, of which 186 represented a single, isolated injury, while 54 were a repetitive exposure by the same mechanism(s) of injury over time. The time over which an injury episode was repeated ranged from 1 month to 16 years (mean: 4.72 years, standard deviation: 4.70 years). The most frequent mechanisms of injury were blunt force trauma (41.7%) and strangulation (22.1%), while 22.5% of episodes involved multiple mechanisms. The most common within-person overlap of mechanisms was blunt force trauma and strangulation ( n = 21, 31%). The interview quotes demonstrated that the true frequency of IPV-HT may be unknown and/or unable to be recalled, highlighting the challenges in capturing accurate IPV-HT exposure within this population even through in-depth interviews.

Conclusions: This study provides important information on the experience of HT among women with exposure to IPV. Such findings may improve our ability to characterize and understand the injuries resulting from IPV among women, which may, in turn, benefit existing tools for determining experiences of IPV-HT and probable brain injury.

Objective: To examine sex differences in exposure to military sexual trauma (MST), intimate partner violence (IPV), and traumatic brain injury (TBI) and their associations with new-onset mental health conditions in United States (U.S.) veterans.

Setting: Retrospective analysis using Defense Health Agency (DHA) and Veterans Health Administration (VHA) data.

Participants: U.S. service members and veterans (SMVs) who 1) served after September 1, 2001, (2) received DHA health care in ≥3 years between 1999 and 2019, (3) received VHA health care in ≥2 years between 2000 and 2019, and (4) completed MST screening. Participants were excluded if (1) TBI status was unclear, (2) had penetrating head injury, (3) age ≤17 years at the simulated TBI index date, or (4) TBI index date occurred before medical record availability.

Design: Retrospective cohort study.

Main measures: Exposure to MST, IPV, TBI, and mental health conditions (eg, post-traumatic stress disorder) were obtained from health records. Index date was TBI diagnosis date or simulated based on age. Sex differences in MST, IPV, and TBI, and their associations with mental health diagnoses after index date were examined.

Results: Of 2 530 847 SMVs in the Long-term Impact of Military-relevant Brain Injury Consortium Phenotype study, 1 249 848 (18.2% female) were included. TBI was more prevalent among men (P < .0001), while MST and IPV were more prevalent among women (P < .0001). Veterans with TBI, MST, or IPV had higher risk of developing a new-onset mental health condition after the index TBI, with highest risk among veterans with cumulative trauma exposures (eg, TBI + MST + IPV).

Conclusions: Female veterans demonstrated the highest prevalence of MST/IPV exposures, but veterans with cumulative trauma exposures had higher risk of developing a mental health condition following index TBI. Thus, screening for both TBI and interpersonal trauma history would help identify veterans who may benefit from additional services and are at greatest risk for deleterious long-term mental health consequences.

Objectives: To investigate gender differences in seeking and receiving healthcare following mild traumatic brain injury (mTBI).

Setting: Participants were recruited from 6 emergency departments and 2 urgent care facilities in the Greater Vancouver Area, Canada.

Participants: 254 adults (56% women, 2% gender-diverse; aged 18-69 years) who presented to emergency department/urgent care within 72 hours after mTBI and were randomized to usual care in the parent study.

Design: Secondary analysis of a clinical trial evaluating the effectiveness of a guideline implementation tool for managing mental health complications after mTBI (ClinicalTrials.gov Registry: NCT04704037).

Main measures: Self-reported use of rehabilitation and health services were assessed with questionnaires at 3- and 6-months post-injury. Chief symptoms, prescribed interventions and referrals to specialists within 6 months post-injury were extracted from general practitioner (GP) charts. Post-concussion symptoms were assessed using the Rivermead Post-Concussion Symptoms Questionnaire, and mental health symptoms using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Primary Care Post-Traumatic Stress Disorder (PTSD) for DSM-5 at 6 months post-injury. Perceived need for mental health care was assessed with an adapted interview version of the Perceived Need for Care Questionnaire.

Results: Approximately 62% of men and 74% of women reported visiting their GP within 6 months after mTBI. They received similar interventions and referrals from GPs. Besides GP visits, no substantial differences were found in use of allied health and rehabilitation services. Women reported more severe post-concussion and mental health symptoms and more frequently having unmet mental health care needs (32% vs 19%).

Conclusions: Women reported worse symptoms but did not receive more specialty clinical care. Women are more likely to report having under-treated mental health problems. Future studies are needed to confirm whether women have a greater mismatch between their need for and receipt of rehabilitation services and explore mechanisms contributing to this gap.

Objective: To examine sex- and age-related differences in patterns of post-concussive symptoms (PCS), across cognitive, somatic, emotional, and behavioral domains, and their recovery within the first 6 months after mild traumatic brain injury (mTBI), and their relation to participation.

Setting: Data were collected from patients visiting the emergency departments of 14 hospitals in the Netherlands.

Participants: Two hundred 8 to 17-year-old children with mTBI and their caregivers, and 186 adults with mTBI.

Design: Data were collected in 2 prospective cohort studies, with assessments at 2 weeks and 6 months post-injury. Data were analyzed using Multivariate Latent Class Growth Analysis to detect latent PCS patterns (classes), multivariate logistic regressions to assess age and sex differences between classes, and Kruskal-Wallis tests to investigate class differences in participation.

Main measures: PCS were assessed with the Health and Behavior Inventory (children) and the Rivermead Post-Concussion Symptoms Questionnaire (adults). Participation (being involved in daily life situations) was assessed with the Child and Adolescent Scale of Participation (children) and the Utrecht Scale for Evaluation and Rehabilitation-Participation (adults).

Results: Three distinct classes with unique PCS recovery trajectories were found across samples (children/caregiver, adults). In child-reported PCS, sex differences were found, driven by higher levels of somatic and emotional PCS in females. No sex differences were found in caregiver reports or in adult reports. Age differences were found in the caregiver report for the child sample, with higher ages found in the class showing decreasing somatic symptoms over time, and in the adult sample, where younger individuals were more often in the class with recovered PCS. Classes differed in their levels of participation in all samples.

Discussion: Findings highlight the heterogeneity of PCS across the lifespan as well as the variation of discrepancies in sex- and age-related findings. Taking age and sex differences into account increases our understanding of recovery patterns after mTBI and allow identification of at-risk individuals and better-tailored interventions.

Objective: To evaluate the efficacy of Online EmReg, a telehealth group intervention to improve emotion regulation (ER) in individuals with traumatic brain injury (TBI).

Design: Randomized controlled trial with the waitlist control (WL) group.

Participants: A total of 109 individuals with TBI (66% mild; 34% moderate/severe) and deficits in ER.

Intervention: Twenty-four biweekly sessions of Online EmReg.

Measures: Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, Satisfaction With Life Scale, Problem Solving Inventory, Dysexecutive Questionnaire.

Results: Significant improvements in ER were noted in both the immediate start and the WL groups by the end of the treatment. Significant differences in ER were found between the immediate start end-of-treatment scores and the WL treatment-onset scores on the Difficulties in Emotion Regulation Scale. No changes were found between end-of-treatment and follow-up assessment scores in either group. The rate of improvement was similar for both groups during the treatment phase. Significant improvements were also noted on self-report measures of affect, satisfaction with life, and executive functioning.

Conclusions: Evidence supports the efficacy of Online EmReg to improve ER following TBI.

Objective: To describe the approach to, accuracy, and variability of neuro-prognostication for patients with severe traumatic brain injury (TBI) among clinicians caring for these patients.

Setting: Data were collected via an anonymous electronic survey.

Participants: The survey was emailed to all clinicians who care for patients with TBI at a Level 1 Trauma Center.

Design: In this observational survey study, respondents were provided vignettes of 3 real patients with TBI and asked to predict 2-year Glasgow Outcome Scale-Extended (GOS-E) scores and 6-month risk of mortality and unfavorable outcome (GOS-E <4). Medical management decisions and approach to goals of care discussions were queried. Results were collected anonymously.

Main measures: Primary outcome measure was prognostic variability. Secondary outcome measures included overall prognostic accuracy and incidence of management recommendations overall and by clinical role.

Results: Of the 55 respondents, 16 (29%) were attending physicians, 19 (35%) residents or fellows, 6 (11%) advanced practice providers, and 14 (25%) nurses. The accuracy of prognostication based on initial patient presentation was 15%. The range of responses for predicted outcome for each patient spanned all GOS-E scores (1-8), and responses for predicted probability of 6-month mortality ranged from 0% to 99% for each patient.

Conclusion: Prognostication accuracy was low, and predictions were highly variable, including all possible neurologic outcomes and mortality ranges. Decreasing the variability in neuro-prognostication for patients with severe TBI is critical.

Objective: To evaluate the effect of using a smartphone application to track mood on emotional quality of life (QoL) outcomes (positive emotion, negative emotion, and sense of self) in persons with traumatic brain injury (TBI) in the postacute period of recovery.

Setting: Community in the southwestern United States.

Participants: In total, 127 community-dwelling adults with medically documented complicated mild to severe TBI.

Design: Randomized, parallel group, wait-list-controlled trial of Mood Tracker, a 6-week intervention requiring participants to self-report mood using a smartphone application.

Main measures: TBI-QoL item banks.

Results: Comparing groups using Wilcoxon rank sum tests, analyses revealed a positive change in sense of self (P = .02) and a marginal positive change in negative emotion (P = .06) pre-to-post intervention, largely driven by the effect on subjective depressive symptoms. Effect sizes were generally small (Cohen's d = .272-.320). There were no significant effects on positive emotion (P = .98).

Conclusions: Persons with chronic TBI can use smartphone technology for self-reporting mood multiple times per week, which shows some promise for improving emotional QoL. Large variation in outcomes suggests that further research is needed to determine who is most likely to benefit from this type of intervention and what additional intervention components are needed to maximize effects.

Objective: The American Congress of Rehabilitation Medicine (ACRM) substantially revised its diagnostic criteria for mild traumatic brain injury (mTBI) in 2023, encompassing acute symptoms and positive clinical and laboratory examinations, in addition to immediate signs of injury. This study aimed to apply these criteria to a large, diverse cohort and compare the diagnostic determination to physician impression of injury.

Setting: A network of 3 concussion specialty clinics in Ontario, Canada.

Participants: A total of 1447 patients (61.0% female; median age = 26 years [IQR: 15-42 years, range: 3-87 years]; days post-injury (median: 23 IQR: [13-47, 0-349]) completed initial evaluations between June 28, 2024 and June 18, 2025.

Design: Prospective observational study.

Main measures: Occurrence rates were calculated, and binary/ordinal logistic regressions were applied to determine if individual criterion endorsement or diagnostic outcome ("Definite," "Suspected," and "No mTBI") was associated with age, sex, symptoms at clinical presentation, or days post-injury. Additionally, concordance with physician impression was assessed similarly.

Results: Criteria for signs, symptoms, and clinical examinations were all more likely to be endorsed with increasing symptom severity at presentation, as was an ACRM diagnostic outcome of definite mTBI. Shorter time post-injury was associated with positive clinical/laboratory examinations and the presence of confounding factors, in addition to a definite diagnostic outcome. A total of 18.4% of cases were classified less definitively as mTBI by physician impression than by the updated ACRM diagnosis, with physicians tending toward underdiagnosis, particularly in patients reporting lower current symptom severity.

Conclusion: Use of the ACRM criteria clinically to determine if an injury qualifies as mTBI may be less susceptible to bias from ongoing symptom reporting than the physician impression of the injury.