Journal of Head Trauma Rehabilitation最新文献

Objective: To examine whether pediatric mild traumatic brain injury (mTBI) is associated with differences in neurocognitive functioning among children.

Setting: Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study.

Participants: Children with mTBI were compared to two control groups: children with orthopedic injury (OI) and children with no injury (NI). After excluding those with moderate/severe TBI, 450 children were classified as having mTBI, 1604 with OI, and 9814 with NI.

Design: This is a cross-sectional analysis using the baseline data from a longitudinal observational study. Neurocognitive performance was assessed using task-based cognitive tests, including the National Institutes of Health Toolbox Cognition Battery (NIHTBX), Rey Auditory Verbal Learning Test, and the Little Man Task. Multiple imputation was used to address missing data. Linear regression models were used to compare cognitive performance across groups, adjusting for age, sex, race, ethnicity, parental income, parental education, and genetic ancestry.

Main measures: The primary outcomes include the principal component scores representing General Ability, Executive Function, and Learning/Memory.

Results: Unadjusted analyses showed children with mTBI had significantly higher scores than NI children on all three principal components. However, no significant differences remained after adjusting for confounders. No differences were found between mTBI and OI groups. Sensitivity analyses further adjusting for behavior and white matter microstructure resulted in same findings.

Conclusion: After adjusting for demographic and genetic factors, no significant differences were found between children with mTBI and OI/NI. The findings highlight the importance of accounting for demographic, socioeconomic, and genetic confounders, as well as selecting appropriate control groups, when analyzing cognitive differences of children with mTBI.

Objective: This study examined false-positive rates and associated factors on the Vestibular/Ocular Motor Screening (VOMS) in healthy US Army Special Operations Command (USASOC) personnel using the symptom provocation cutoff of ≥1 for any VOMS item as recommended in the Military Acute Concussion Evaluation 2 (MACE 2).

Setting: Military site.

Participants: Active-duty USASOC personnel aged 18 to 40 years with 20/20 vision, no duty limitations, and no recent concussion. Participants were excluded if they had a history of vestibular or neurologic disorder, only monocular vision capabilities, or previous moderate-to-severe traumatic brain injury. Four hundred and sixteen USASOC personnel were enrolled; 402 were analyzed.

Design: This was a cross-sectional study of diagnostic accuracy. Trained research personnel administered the VOMS. Participants and research personnel were not blinded.

Main measures: False-positive rates and associated risk factors on the VOMS.

Results: Among 402 healthy participants (mean age 28.5 ± 5.7 years), 35.1% had at least one false positive on the VOMS. Twenty-two percent had at least one false-positive change score, 12.2% had a near-point convergence (NPC) distance ≥5 cm, and 4.2% had both. VOMS false positives on each VOMS item ranged from 4.7% to 15.7%. Participants with ≥1 false positive on the VOMS were more likely to have a motion sickness history (OR = 2.35, 95% CI = 1.35-4.12, P = .003) or a concussion history (OR = 1.97, 95% CI = 1.27-3.05, P = .002).

Conclusion: The MACE 2 cutoff resulted in a higher overall rate of at least one false positive across items (35.1%) in this sample of healthy USASOC personnel compared to prior total score cutoffs. Consistent with previous research, a history of motion sickness or concussion was associated with an increased likelihood of false positives. Multivariate predictors included motion sickness and a history of concussion. Military medical providers should consider motion sickness, history of concussion, and performance on individual VOMS items.

Objective: First, to summarize the design of novel decision aid prototypes aimed at facilitating shared decision-making for Veterans with co-morbid mild traumatic brain injury (mTBI) and sleep disorders (insomnia, obstructive sleep apnea [OSA]) in the Veterans Health Administration (VHA) Polytrauma/TBI System of Care (PSC). Second, to elicit feedback regarding usability, acceptability, and feasibility of prototypes to inform future implementation.

Setting: Nationwide VHA PSC sites.

Participants: Clinicians included VHA providers involved in the management of mTBI and/or sleep disorders in the VHA PSC (n = 7). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and OSA within the past year (n = 5).

Design: Convergent parallel mixed methods.

Main measures: Semi-structured interview guides; System Usability Scale; Ottawa Decision Aid Acceptability Scale.

Results: Participants found the decision aid prototypes easy to use, highlighting its accessibility and features enabling an easy comparison of treatments. However, participants recommended changes to simplify and improve the design. Decision aids were seen as acceptable, providing essential information for Veterans with mTBI and facilitating shared decision-making among providers, Veterans, and other decision partners (eg, spouse). Removal of non-essential content was recommended to increase acceptability. Decision aids were considered feasible to implement, though extending the decision-making process beyond the initial encounter and accounting for time constraints were recommended.

Conclusions: Findings highlight that the decision aids are easy-to-use, feasible to implement, and capable of improving Veteran-centered management of sleep disorders among those with mTBI. Nonetheless, clinicians and Veterans offered recommendations for changes that can improve the utility of the decision aids and facilitate their seamless integration into routine care for Veterans with co-morbid mTBI and sleep disorders. Findings lay the foundation for efforts aimed at implementing the decision aids into routine care for sleep disorders in the VHA PSC, aligning care decisions with Veteran preferences and improving outcomes.

Objective: To test cross-lagged associations among sleep, headache, and pain in pediatric mild traumatic brain injury (mTBI).

Setting, participants, design: Children and adolescents aged 8.0 to 16.9 years who sustained a mTBI and presented to 1 of 5 pediatric emergency departments across Canada completed assessments at 1-week, 3 months, and 6 months post-injury as part of a larger prospective cohort study.

Main measures: Sleep disturbance was measured using 7 sleep items from the Child Behaviour Checklist. Sleep duration was measured using average weekday and weekend sleep from the Healthy Lifestyle Behaviours Questionnaire. Pain intensity was measured using an 11-point numerical rating scale. Headache severity and associated functional impairment were measured using the Headache Impact Test and 1 item from the Health and Behaviour Inventory. Analyses included trivariate-indicator random-intercept cross-lagged panel models.

Results: Of 633 recruited children, 563 were included in the current study. Headache showed significant within-person, bidirectional, cross-lagged associations with sleep disturbance and duration, as well as with pain intensity. More specifically, worse headache predicted greater sleep disturbance (1-week to 3 months and 3 months to 6 months: B s = .47, P s ≤ .013) and shorter sleep duration (1-week to 3 months: B = -.21, P = .006), while greater sleep disturbance predicted worse headache (1-week to 3 months: B = .08, P = .001). Worse headache also predicted higher pain intensity (1-week to 3 months & 3 months to 6 months: B s ≥ 1.27, P s < .001), while higher pain intensity predicted worse headache (3 months to 6 months: B s ≥ .03, P s ≤ .042). No cross-lagged associations involving sleep disturbance or duration with pain intensity were significant.

Conclusions: Significant bi-directional, cross-lagged associations exist between headache and both sleep and pain. The findings suggest that early intervention for headaches may help prevent later sleep disturbance and pain after pediatric mTBI.

Objective: To investigate the associations between current chronic pain and cognition and current chronic head pain and cognition in individuals with traumatic brain injury (TBI).

Setting: Community.

Participants: A total of 1762 participants from the TBI Model Systems who endorsed experiencing current chronic pain and who completed the Current Chronic Pain survey.

Design: Secondary analysis of a subset of data collected through a multi-site, cross-sectional observational cohort study.

Main outcome measures: Cognition as measured by the Brief Test of Adult Cognition by Telephone (BTACT).

Results: Individuals with TBI who reported current chronic pain exhibited lower cognitive performance compared to those who reported no pain. Among individuals who reported pain, greater pain intensity and pain interference were negatively associated with cognition, resulting in poorer cognitive performance. The negative association was even greater for individuals acknowledging chronic head pain compared to pain from other body locations.

Conclusion: The negative association between current chronic pain and cognition for individuals with TBI indicates the need to consider pain intensity and pain interference as factors possibly influencing cognitive ability.

Objective: Examine if the mandated Veterans Affairs traumatic brain injury (TBI) screen is associated with long-term postconcussive symptoms as compared to how the mandated mental health (MH) screen is associated with long-term MH symptoms.

Setting: Veterans Health Administration.

Participants: Patients (N = 1628) who were previously screened for TBI with current postconcussive symptoms and MH conditions completed a survey assessing current postconcussive symptoms, depression, posttraumatic stress disorder, alcohol use, and physical and emotional well-being. Participants were mostly male (83%), less than 40 years old (38%), and identified as White (64%). Forty-five percent screened positive for MH conditions; 11% screened positive for TBI.

Design: Cohort survey study of random sample of post-9/11 veterans combined with retrospective database analysis. Bayesian Network Analysis was used to compare how the TBI and MH screens related to long-term postconcussive and MH symptoms. The pathway on the Bayesian Network graph leading to postconcussive symptoms was thoroughly examined with a regression.

Main measures: Neurobehavioral Symptom Inventory to measure postconcussive symptoms.

Results: A Bayesian network arch demonstrated TBI screening was related to use of TBI services within 6 months after the screening but not related to long-term postconcussive or MH symptoms. In comparison, the MH screen led to post-screen MH services, postconcussive symptoms, and most of the other secondary outcomes, including posttraumatic stress disorder and depression. The regression model showed that a positive MH screen, more MH service use, negative life events, and moderate depression were associated with greater postconcussive symptoms years after screening.

Conclusion: While both TBI and MH screening were associated with increased service use, only the MH screen was associated with long-term postconcussive symptoms. Findings raise questions about whether the TBI screening program adds value over and above the MH screening program.

Objective: To understand how traumatic brain injury (TBI) clinical severity and military factors were associated with the likelihood of receiving a TBI service-connected disability (SCD) determination and monthly total SCD compensation among Veterans.

Setting: Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA).

Participants: 1 319 590 veterans with a VBA SCD rating who entered the VHA between October 1, 2000, and September 24, 2019.

Design: This retrospective study analyzed the association of TBI severity and military factors with a TBI SCD determination, TBI SCD rating percentage, and monthly total SCD compensation. Administrative VHA and VBA records were utilized.

Main measures: Any TBI SCD determination, TBI SCD rating percentage, and monthly SCD compensation.

Results: 93 911 (7.1%) Veterans had an SCD rating for TBI. TBI SCD increased monthly total compensation by $362 (95% CI 353, 370) in bivariate and $45 (95% CI 38, 52) in adjusted models. Females had lower TBI SCD percentage (-3.03; 95% CI -3.92, -2.14) but higher monthly compensation ($37; 95% CI 33, 42). TBI severity was associated with increasing TBI SCD percentage and monthly SCD compensation. In adjusted models, deployment (-2.36; 95% CI -3.02, -1.69) was associated with lower TBI SCD percentage but not monthly compensation, while combat exposure was not associated with TBI SCD percentage but was associated with higher compensation ($46; 95% CI 40, 53).

Conclusion: TBI severity was significantly associated with TBI SCD determination and TBI SCD rating percentage, in addition to overall SCD compensation. Although deployment was significantly associated with TBI SCD determination, non-deployment was associated with higher TBI SCD percent ratings. These results may be explained by TBI occurring in non-deployment military settings, such as training. This highlights the need to study risk for TBI in the general military environment to ensure that all military-related TBI exposures are recognized and that any related disability is appropriately compensated.

Objectives: The purpose of this study was to assess gait related dual task cost (DTC) changes over the course of a collegiate athletic career in both repetitive head impact (RHI) exposed and non-RHI exposed athletes.

Setting: University Research Laboratory.

Participants: We recruited 47 NCAA intercollegiate athletes and grouped by RHI exposed (N = 27) and non-RHI (N = 20) sports.

Design: Participants completed 5 trials of single task (ST) and 5 trials of dual task (DT) gait with a working memory cognitive challenge both prior to their collegiate athletic careers (pre) and then again after they completed their collegiate athletic careers (post) (mean 1173 ± 341 days between tests) in this prospective longitudinal design. To assess for changes over the course of a career, separate 2 (group: RHI, non-RHI) × 2 (time: pre, post) mixed design ANOVA were performed for each dependent variable of interest (DTC gait velocity and DTC step length) and the model was adjusted for concussion history at the time of test and sex.

Main measures: Gait velocity and step length DTC.

Results: There were no significant group by time interactions for DTC gait velocity (F = 0.517, P = .476, η 2 = 0.012) or DTC step length ((F = 0.206, P = .652, η 2 = 0.005).

Conclusions: The primary finding of this study indicated no difference between RHI exposed and non-RHI exposed athletes gait DTC performance between the beginning and conclusion of their collegiate athletic careers. While the long-term effects of RHI remain to be fully determined, these results suggest that RHI may not adversely affect ST or DT gait performance when the individual is young.

Objective: To estimate the relative causal influence of physical and mental health on pain in persons with traumatic brain injury (TBI) within the year following injury.

Setting: Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) was a multicenter study that collected data from 18 level 1 trauma centers around the United States.

Participants: TRACK-TBI recruited adults who experienced an acute TBI. For this secondary analysis, participants were included if they endorsed pain during at least 1 follow-up within 1 year post-TBI.

Design: Secondary analysis using structural equation modeling of the longitudinal TRACK-TBI dataset of an inception cohort.

Interventions: None.

Main outcomes and measures: The primary outcomes are pain, physical health, and mental health. Pain was measured by averaging the T-scores of the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity and Pain Interference scales. Physical and mental health were measured with the raw component scores (physical component score and mental component score, respectively) on the Short Form Health Survey.

Results: Eighty-nine percent of the TRACK-TBI cohort (n = 2022) reported pain throughout 1 year postinjury. This sample (n = 1796) was primarily white (77%) men (67%) in their early forties with mild (87%) closed head injuries (99%) related to motor or road vehicle accidents (57%). Based on the final trimmed model, there was a stronger dominance of pain on physical and mental health than physical and mental health on pain. Thus, pain is a bigger driver of physical and mental health than vice versa.

Conclusions: Persistent pain is highly prevalent post-TBI and is a bigger driver of physical and mental health 1 year post-TBI than the other way round. Future research should aim to better understand the causes of pain post-TBI to inform what treatments are most effective at reducing pain intensity and interference post-TBI.

Objective: This study aims to evaluate vestibular function by instrumental assessment of the angular vestibulo-ocular reflex (aVOR) in survivors from severe traumatic brain injury (sTBI) and analyze related clinical characteristics and functional balance scales.

Setting: This study was conducted on inpatients accepted at Santa Lucia Foundation-Neurorehabilitation Hospital for Research and Healthcare (Rome, Italy), from January to September 2023.

Participants: Twenty-one survivors from sTBI with a median age of 48 years (IQR = 27) were included in this study, recruited through the neurorehabilitation services. Participants were included if they had a Glasgow Coma Scale Score ≤ 8 at the time of injury, Level of Cognitive Functioning ≥ 7, static and dynamic balance impairments, ability to understand verbal commands, and Functional Ambulation Classification > 3.

Design: Cross-sectional study.

Main measures: Two expert physiotherapists performed an aVOR assessment using the video Head ImpulseTest by both head impulse and suppression paradigms. Furthermore, all participants completed a balance assessment using the Berg Balance Scale and the Mini-Balance Evaluation Systems Test (Mini-BESTest) scale. Descriptive statistical analyses were performed, and the relationship between aVOR function and balance outcomes was investigated.

Results: Nineteen participants (90%) displayed aVOR with an abnormal gain at least in 1 canal. Thirty percent of all canals analyzed had abnormal gains, with a clear prevalence of the right posterior canal (71%), which presents aVOR gain lower than the functional threshold on average (mean 0.70; CI, 0.62-0.78). No correlations were found between the aVOR gain and the clinical outcome measure scores.

Conclusion: Low aVOR gains were evident in people who experienced sTBI. A comprehensive evaluation of the vestibular peripheral system may detect vestibular impairments in these patients that may otherwise be unrecognized.