Brain injury最新文献

Introduction: Athletes with concussions experience heterogeneous symptoms and clinical trajectories. Subclassification provides diagnostic clarity that may improve prognostication and individualized treatments.

Methods: We hypothesized that endophenotypes of adolescent athletes with concussions differ based on sex and time since injury. Post-concussive testing was performed for athletes (n = 1385) in the North Texas Concussion Registry (ConTex) at four timepoints: acute [0-3 days post-injury (DPI)], subacute-early (4-7DPI), subacute-late (8-28DPI), and persistent (29+DPI). Six endophenotypes (cognitive, headache, ocular-motor, vestibular, affective, sleep) were constructed by allocating post-concussion testing data elements described by the Concussion Subtype Workgroup.

Results: Endophenotypes were defined using correlations between data elements and compared based on sex or time since injury. Correlograms revealed endophenotypes differed based on sex and time since injury. The affective endophenotype was dependent on the interaction between sex and time since injury and was more prevalent at the subacute-late and persistent timepoints. The sleep endophenotype became more prevalent at the persistent timepoint. Affective and sleep endophenotypes were interrelated with cognitive, vestibular, and headache endophenotypes at the persistent timepoint suggesting that dysregulated mood and sleep influence lingering symptoms.

Conclusions: Adolescent symptom-based concussion endophenotypes differ based on sex and time since injury. Clinical consideration may improve identification of separate trajectories following sport-related concussion and provide targeted care.

Background: Social isolation is prevalent after traumatic brain injury (TBI) and has negative implications for health and well-being. Interventions targeting social participation show promise for reducing social isolation. We adapted a social participation intervention, ENGAGE, to meet the needs of people with TBI. ENGAGE relies on social learning and guided problem-solving to achieve social participation goals.

Methods: This study was conducted in two phases. First, we conducted focus groups with 12 participants with TBI to inform adaptations. We then tested the adapted protocol (n = 6). Post-intervention interviews informed additional refinements. We collected preliminary data on feasibility and effects on social participation (Activity Card Sort, PROMIS Ability to Participate in Social Roles, PROMIS Satisfaction with Participation in Social Roles) and social isolation (PROMIS Social Isolation).

Results: Intervention adaptations included simplified processes for developing goals and plans, simplified workbook materials, greater time for reflection on lessons learned, and expanded peer mentorship. ENGAGE-TBI resulted in high satisfaction for 80% of participants and high engagement in intervention for 100% of participants. Attendance and retention benchmarks were achieved. Improvements in social participation exceeded the minimal clinically important difference on all measures.

Conclusions: The promising preliminary data support further investigation into the feasibility and effects of ENGAGE-TBI.

Purpose: To understand the experience of community and social participation for people with severe ABI during inpatient rehabilitation and the transition years.

Methods: Constructivist grounded theory methodology informed participant recruitment and data analysis. Adults with ABI were recruited using purposive sampling and data collected via in-depth interviews.

Results: Thirteen adults with severe ABI participated, with average age of 36.7 yrs at the time of injury, 9.1 months length of stay of in inpatient rehabilitation, and 4 years post discharge from hospital at time of interviews.The core category developed from thematic analysis was 'lack of focus on community and social participation.' Additional categories included: restricted participation, a focus on impairment and function, acceptance and connection within the community, influence of family and delayed return to community participation.

Conclusion: Community and social participation are recognized as the goal of rehabilitation following ABI; however, experiences shared by participants revealed that community and social participation were not the focus of their rehabilitation.

Implications for rehabilitation: To support positive holistic outcomes, focus on community and social participation is required within the rehabilitation continuum, using participatory frameworks, contextual goal setting, transparent endorsement for community access and the provision of opportunities for meaningful experiences with family and friends.

Objective: Brain ischemia is considered an extremely potent stress factor at the cellular and molecular level which may lead to massive neuronal death. Alternatively, short brain ischemia and reperfusion (I/R) can actually stimulate neurogenesis, angiogenesis and peptidergic signaling. There is little known about the potential effect of I/R on brain expression of the novel neuropeptide; phoenixin (PNX) and its receptor GPR173.

Methods: The study was carried out on adult male Wistar rats divided into seven groups: control, sham operation and 5 ischemic experimental groups across the time course of reperfusion. We examined mRNA and protein expression of GPR173 and neurogenesis markers Musashi-1, doublecortin (DCX), and Sox-2 in the striatum.

Results: GPR-173 positive cells were found only in the ischemic hemisphere, where Musashi-1, DCX and Sox-2-positive cells were also observed. Gene expression analysis also showed a significant increase of GPR-173 mRNA level in the I/R striatum in comparison with the control one. Results confirm previous findings suggesting that I/R stimulates adult neurogenesis in the striatum and affects peptidergic signaling in this structure.

Conclusions: A very fast occurence of GPR-173 expression revealed in the striatum may potentially be exclusively related to neuroprotective neurochemical changes that occur in this region after I/R.

Objective: Persistent post-concussive symptoms (PPCS) are common and disruptive, particularly in military service members (SM), yet there are no approved therapies targeting underlying physiological processes. This study was designed to compare acoustic neuromodulation using Cereset Research™ Standard Operating Procedures (CR-SOP), with Cereset Research Cranial Electrical Stimulation (CR-CES), on PPCS.

Methods: SM, veterans, or dependents with PPCS (Neurobehavioral Symptom Inventory [NSI] Score ≥23) were randomized to receive 10 sessions of engineered tones linked to brainwaves (CR-SOP) or 5 sessions of CR-CES, which adds intermittent low voltage transcranial alternating current stimulation (tACS) to CR-SOP. Designed to assess non-inferiority between varied doses of CR-SOP and CR-CES, the primary outcome was a change in post-concussive symptoms on the NSI, with secondary outcomes of heart rate variability (HRV) and self-report measures of PTSD, sleep, headaches, and depression.

Results: Among study participants (n = 80, 21.3% female, mean age 40.2 [SD 13.2], 4.8 deployments, 3.2 TBIs), mean NSI declined from 45.6 to 29.5 after intervention (p < 0.0001), with gains sustained at 3 months (29.7). No significant between group differences for NSI (CR-SOP: baseline 43.9, post-intervention 26.0, 3-month 27.2, and CR-CES 46.4, 30.7, and 31.1, respectively), and no evidence of inferiority between the groups with respect to NSI. Similar improvements were seen on PCL-5, ISI, HIT-6, and PHQ-9, with no HRV differences between groups.

Conclusion: Both acoustic neuromodulation alone (CR-SOP) and a lower dose of CR-SOP, with tACS added (CR-CES), significantly improved PPCS out to 3 months.

Registration: ClinicalTrials.gov - NCT03649958.

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.

Objectives: Medical complications occur frequently in MCS and influence advance medical decision-making. This study aimed to report on medical complications and advance medical decision-making in a nationwide group of MCS patients.

Methods: In this descriptive cross-sectional study, clinical and advance medical decision-making characteristics were collected in a survey, completed by the treating physician.

Results: The MCS population consisted of 32 patients: 65.6% traumatic etiology, 68.8% male. Patients had a median of five complications: hypertonia/spasticity (81.3%) and pneumonia (50.0%) occurred most frequently. Most patients had curative goals: three patients had a fully curative treatment scenarios, 29 a curative scenario with ≥ 1 treatment restrictions, two a palliative and two a symptomatic scenario. Conversations about advance medical decision-making were complicated by disputes with next of kin, inability to evaluate medical treatment because of medical instability, next of kin not being ready to discuss medical treatment, or a treatment scenario explicitly based on requests of next of kin.

Conclusion: Medical complications are common in MCS patients and advance medical decision making was complicated. This legitimates realization of specialized care across acute, post-acute and long-term care. Further longitudinal research into advance medical decision-making is recommended.

Primary objective: The purpose of this study was to explore how 'quality' is understood for traumatic brain injury (TBI) rehabilitation from the perspectives of the rehabilitation recipients, their families and the providing clinicians.

Research design: A participatory study using a mixed-methods, triangulation design.

Methods: The study involved 1. a systematic literature search; 2. Individual semi-structured interviews with people with TBI and/or their caregivers and TBI rehabilitation clinicians, and 3. an online consensus process.

Outcomes and results: 22 participants (7 people with TBI, 8 caregivers, 7 clinicians) participated in individual interviews. Their transcribed data were coded into broad categories via in-depth reflexive, thematic analysis; these categories were then mapped to 13 quality domains extracted from the literature. The emergent themes were then presented to the individuals, via an electronic consensus tool in two rounds. This resulted in 12 prioritized domains of quality that encompass service features, staff qualities and effectiveness.

Conclusion: These evidence-informed and consensus-agreed indicators for quality may help guide both the provision and evaluation of TBI rehabilitation, that is valued and meaningful.

Objective: To investigate brain injury (BI) associations' perspectives regarding the impacts of the second year of the COVID-19 pandemic on individuals with BI and BI associations services across Canada.

Methods: This qualitative descriptive study included 26 representatives of Canadian BI associations that participated in six online focus groups to discuss the effects of the second year of the pandemic on clients living with BI and on the provision of community services.

Results: Findings revealed three main themes: 1) ongoing pandemic-related challenges faced by clients living with BI, including worsening mental health and basic needs insecurities, difficulties faced by clients in adhering to safety measures, and ongoing technological issues; 2) ongoing adaptations to accommodate clients' needs, including offering tailored services, ensuring consistent and transparent safety measures, and providing hybrid services; and 3) developing a sustainable 'new normal' aligned with association mandates and resources by expanding networks and building resilience.

Conclusion: The unfolding of the pandemic has brought increased challenges for people with BI and reinforced the need for adapted, clear, and accessible public health information to ensure the safety of vulnerable populations in times of crisis. It is essential to bolster community-based associations that provide direct care to people with BI.