Brain injury最新文献

Primary objective: Part IV concludes this four-part review of 'What Traditional Neuropsychological Assessment Got Wrong About Mild Traumatic Brain Injury,' with a focus on clinical applications and future directions.

Methods and procedures: These reviews have highlighted the limitations of traditional neuropsychological assessment methods, particularly in the evaluation of the patient with mild traumatic brain injury (mTBI), and especially within the context of all of the 21^st Century advances in neuroimaging, quantification and network neuroscience.

Main outcome and results: How advanced neuroimaging technology and contemporary network neuroscience can be applied to assessing the mTBI patient at this time along with neuroimaging of the future are reviewed. The current status of computerized neuropsychological test (CNT) development is reviewed as it applies to mTBI assessment. Likewise, how the future of various types of virtual reality (VR), artificial intelligence (AI), wearable sensors, and markerless gaming technology could enhance the mTBI CNT assessment tool box of the future is reviewed.

Conclusions: The review concludes with some aspirational statements about how improvements along with novel CNT methods could be developed and integrated with advanced neuroimaging technologies in the future to be tailored to meet the needs of the mTBI patient.

Objective: To develop a pneumonia risk score for patients with severe acquired brain injury (sABI) hospitalized for post-acute rehabilitation.

Methods: A prognostic model with data from 1,625 patients with sABI who were pneumonia-free at admission for rehabilitation. Candidate predictors were gathered within 72 hours following admission. Prognostic risk scores were calculated based on hazard ratios and combined in an overall pneumonia risk score ranging 0-10.

Results: Predictors were age >50 years hazard ratio (HR) 1,83 (95% CI: 1.33; 2.53), male sex HR 2.43 (95% CI: 1.70; 3.46), diagnosis (stroke, traumatic or anoxic brain injury) HR 1.69 (95% CI: 1.12; 2.55), tube feeding HR 4.46 (95% CI: 2.59; 7.70), and functional independence measure score of 18 HR 2.06 (95% CI: 1.10; 3.85). A score of 8-10 encompassed those being at high-risk of pneumonia with a positive predictive value (PPV) of 35% (95% CI: 32-37), a score of 5-7 encompassed those being at medium risk with a PPV of 16% (95% CI: 14-17), and a score of 0-4 encompassed those being at low risk with a PPV of 4% (95%CI: 3-5).

Conclusions: A prognostic score was developed to raise awareness of patients in post-acute rehabilitation who are at high risk of pneumonia. The prognostic score should be externally validated before being used outside the development setting.

Objective: Loneliness is one of the biggest health concerns in the UK and is recognized as a health priority in Northern Ireland. Following an acquired brain injury (ABI), there is a sudden and catastrophic loss of function, impacting many areas of life, including loneliness. We explored the meaning of loneliness for adults with ABI and the experiences and factors influencing their loneliness.

Design: Qualitative study including three focus groups and four individual interviews, using a semi-structured interview guide, and recorded online.

Methods: Participants were recruited from the Community Brain Injury team caseload. Twenty-three adults (6 female, 17 male), ranging from 2 to 24 years post - ABI, participated. Data were thematically analyzed using a deductive approach, using framework analysis to guide theme development.

Results: Loneliness had a different meaning to participants, yet all experienced it at some point in their journey post-ABI. Four themes were derived from the focus group transcriptions; 1) 'A black hole with no sun' (definition) 2) 'A missing piece' (impairments) 3) 'I've become poor old mum' (identity) 4) 'Our own kind' (coping). Sub-themes were derived providing an in-depth exploration.

Conclusions: Supporting loneliness post-ABI is challenging and multifactorial. Early identification and support by clinical teams is crucial. The findings suggest mechanisms to provide such support, directly from those with lived experience.

Background: Traumatic brain injury (TBI) disproportionately affects Hispanic children, with higher rates of severe injuries and worse outcomes compared to non-Hispanic White children. Patient navigation has shown effectiveness in improving health outcomes among Hispanic populations. However, culturally tailored navigation programs for pediatric TBI are lacking, and knowledge gaps remain regarding contextual factors influencing the implementation of these programs. This study examined factors that facilitate or hinder the implementation of a bilingual and bicultural navigation program for caregivers of Hispanic children with TBIs.

Methods: In-depth interviews were conducted with 12 personnel involved in implementing the 1^st Brain Injury Education and Outpatient Navigation (1^st BIEN) program across four states. Directed content analysis was used based on the Consolidated Framework for Implementation Research (CFIR) to guide the development of the interview guide and data analysis.

Results: Key facilitators included the program's adaptability to patient needs, bilingual/bicultural patient navigator's skills, and alignment with organizational values. Barriers included restrictive healthcare regulatory policies hindering interinstitutional work, incomplete medical records, and gaps in behavioral support training.

Discussion: These findings offer insights for optimizing the implementation of patient navigation programs in pediatric TBI care, potentially improving access to care and reducing disparities for Hispanic children with brain injuries.

Background: Executive dysfunction affects most stroke survivors, limiting their ability to adapt post-stroke. Despite clinical guidelines recommending executive functioning rehabilitation, robust evidence for interventions is lacking.

Aims: This study assessed the feasibility and acceptability of an executive functioning telerehabilitation intervention for stroke survivors. It examined recruitment and retention rates, adherence, completion of outcome measures, intervention usability, and participant experience. Preliminary changes in executive functioning, self-efficacy, and wellbeing were explored to inform the design of a future efficacy trial.

Methods: A feasibility randomized-controlled trial was conducted with 19 adult stroke survivors randomized to receive either an executive functioning telerehabilitation intervention or stroke psychoeducation. Interventions were two 30-minute videos with accompanying homework delivered asynchronously over two weeks. Outcome measures validated in stroke populations assessed executive functioning, wellbeing, and self-efficacy at baseline, post-intervention, and one-month follow-up. Feedback was collected on usability and acceptability.

Results: Recruitment and drop-out rates were acceptable. Participants indicated that both interventions were acceptable, relevant, useful, and easy to engage with, though some found the homework tasks challenging.

Conclusion: The executive functioning and psychoeducation interventions are feasible and acceptable for research. A larger RCT is needed to evaluate efficacy, retaining multiple recruitment sources, including public healthcare services, for representative samples.

Clinicaltrials registration: NCT05461937.

Objective: Posttraumatic amnesia (PTA) following a traumatic brain injury (TBI) is characterized by multiple cognitive and behavioral changes including memory impairment and disorientation. This study aimed to measure changes and relationships between key body functions and activities of daily living (ADL) performance throughout PTA progression and resolution.

Method: A longitudinal observational study was conducted with 24 participants in PTA. PTA was measured daily with the Westmead PTA Scale (WPTAS). As participants achieved a new score on the WPTAS, measures of agitation, attention, balance, visual perception, visual motor and ADL performance were taken. The data were analyzed descriptively and significant improvements in functions were identified using Friedman´s rank tests with post-hoc testing. Relationships between variables were examined using Spearman's rank order correlations.

Results: As PTA resolved, there were gradual and significant improvements in all variables except for visual motor performance. Attention was significantly better when scoring >8-9 on the WPTAS. There were significant correlations between body functions and ADL performance at different timepoints.

Conclusion: Understanding these gradual and interrelated improvements of functions during PTA may facilitate more precise assessment and earlier introduction of interventions to enhance patient outcomes.

Introduction: This study investigated the relationship between trauma patients with TBI who did and did not receive blood product transfusions and the incidence of venous thromboembolism (VTE) hypothesizing transfusions increase VTE risk.

Methods: The Trauma Quality Improvement Program (TQIP) was queried from 2017 to 2021 to identify adult (≥18 years-old) patients with TBI. Patients with TBI receiving any blood product transfusions within 4 h of arrival were compared to those who did not. Outcomes were compared using bivariate analyses and a multivariable logistic regression to identify predictors of VTE.

Results: Of 451,061 patients with TBI, 32,276 (7.2%) patients received a blood transfusion. Thrombotic events were more frequently observed in transfused patients such as VTE (7.6% vs 1.4%, p < 0.001), comprised of deep vein thrombosis (6.0% vs 1.1%, p < 0.001) and pulmonary embolism (2.3% vs 0.4%, p < 0.001). Blood product transfusion was associated with an increased risk of VTE (OR 1.34, CI 1.11-1.62, p = 0.003). However, when individually analyzed, only pRBC transfusion was independently associated with increased VTE risk (OR 1.37, CI 1.24-1.51, p < 0.001).

Conclusions: Trauma patients with TBI undergoing early blood product transfusion had a nearly 50% increased risk of VTE, compared to patients not undergoing transfusion. This risk was primarily attributed to the use of pRBC.

Level of evidence: IV (therapeutic).

Objective: This study evaluated the effect of sleep fragmentation after brain injury on therapeutic engagement and rehabilitation progress in pediatric inpatients.

Methods: Participants (N = 29) wore a wrist accelerometer for one week to calculate a sleep fragmentation index measuring restlessness during the sleep period. Therapists completed ratings of functional independence (using the WeeFIM) and therapeutic engagement (effort and active participation in physical therapy sessions measured using the Rehabilitation Therapy Engagement Scale).

Results: Controlling for time from injury to rehabilitation admission, sleep fragmentation is negatively associated with therapeutic engagement and rehabilitation progress (defined as improvement in WeeFIM scores from admission to discharge per day of rehabilitation). Hierarchical regression demonstrated a significant negative association between sleep fragmentation and rehabilitation progress. However, when therapeutic engagement was added to the model it accounted for a significant portion of the variance and the effect of sleep fragmentation was no longer a significant predictor of rehabilitation progress.

Conclusion: Findings demonstrate the detrimental impact of sleep fragmentation on therapeutic engagement and rehabilitation progress and also suggest a possible mediating role for therapeutic engagement on the effect of sleep fragmentation on rehabilitation progress.

Objective: Extracellular vesicles (EVs) derived from regenerative mesenchymal stem cells might safely treat traumatic brain injury (TBI). We evaluated the safety and efficacy of a human bone marrow derived mesenchymal stem cell EVs (hBM-MSC EV) investigational product (IP) in a patient with severe TBI.

Design: A single case study employing an IP with a strong safety profile in over 200 patients.

Method: The patient was dosed intravenously three times/week in the first week of six successive months. Functional Independence Measure (FIM) and Functional Assessment Measure (FAM) were performed to quantify effects. Safety monitoring was performed every week for nine months.

Results: No adverse events occurred. Within eight weeks FIM and FAM scores improved by 48-55% and were sustained for the entire 36 weeks. All specific outcome items assessed by FIM and FAM that were initially low showed sustained improvements ranging from 41% to 233%, with the greatest improvements seen in locomotion, mobility and cognitive function.

Conclusion: After moderate improvement with conventional therapy, the substantial improvement observed following introduction of the IP suggests that hBM-MSC EVs may offer a novel and safe means to improve TBI patient outcomes. Appropriate randomized, controlled clinical trials to conclusively evaluate this therapeutic option are indicated.

Purpose: To develop a series of infographics providing persons with traumatic brain injury (TBI) and their circle of care with evidence-based information on sex and gender topics in TBI.

Materials and methods: We employed an iterative participatory design engaging knowledge users, scientists, and experts in brain injury and patient education. To inform infographic content, we conducted an information needs assessment with knowledge users through semi-structured interviews and referred to our previously published evidence syntheses on TBI topics. We followed principles of graphic design and science communication to create materials reflecting lived experiences of knowledge users.

Results: We created a series of infographics with actionable messages and visual representations of evidence-based information. We achieved a Flesch Reading-Ease score of 60.1, corresponding to a Grade 7/8 reading level. The infographics met the color contrast criteria of the Web Content Accessibility Guidelines. Knowledge users found the material useful, visually appealing, and helpful in understanding complex topics.

Conclusions: There is value in merging art and science to develop educational materials that meet the unique information needs of knowledge users. Iterative participatory design engaging diverse stakeholders is essential for co-creating knowledge translation tools to improve access to health information and quality of care after TBI.