Brain injury最新文献

Objective: To explore how South African occupational therapists (OTs) assess work readiness (WR) in clients with acquired brain injury (ABI), identify contextual challenges, and propose improvements.

Method: A qualitative descriptive study using thematic analysis of semi-structured interviews with seven OTs experienced in vocational rehabilitation with individuals with ABI. Purposive and snowball sampling was used, and data was manually coded using NVivo 14.

Results: Thematic analysis, informed by the study objectives, identified three main themes: 1) how OTs assess WR 2) contextual influences on WR evaluation, and 3) recommendations for improving WR evaluation in South Africa. OTs use a multifaceted approach when assessing WR, incorporating a variety of assessments to evaluate physical, cognitive, and psychosocial skills, while collaborating with multiple stakeholders. Systemic challenges influence WR, such as unemployment, socioeconomic status, stigma, disparities between the private and public health sectors, lack of knowledge and implementation of labor policies, and the lack of contextually appropriate standardized tests.

Conclusion: Findings suggest that South African OTs evaluate WR comparably to international practices, yet face distinctive systemic barriers that are not typically present in high-income settings. This highlights the need for a contextually appropriate guideline to enhance WR evaluations in individuals with ABI.

Adolescent acquired brain injury (ABI) often results in long-term social challenges, with peer acceptance playing a crucial role in psychosocial outcomes. Hills and Dunsmuir's study highlights how attitudes, subjective norms, and perceived behavioral control influence adolescents' intentions to engage with peers with ABI, explaining 83% of the variance. Notably, perceived behavioral control was the strongest predictor, indicating that even positive attitudes may not translate into inclusion if engagement is perceived as difficult. Externalizing behaviors further reduce the likelihood of peer acceptance. These findings underscore the need for peer-focused interventions, such as structured mentoring, cooperative learning, and social skills programs, to enhance practical inclusion strategies in educational settings. Clinicians and educators should move beyond awareness-raising toward targeted approaches that make social participation with peers following ABI achievable and sustainable.

Introduction: Driving requires the coordination of complex cognitive and motor abilities that are often impaired after brain injury or stroke. This scoping review aimed to synthesize the driving behaviors observed in individuals with brain injury through simulator-based and on-road driving assessments using Michon's hierarchical framework.

Methods: Following the PRISMA extension for Scoping reviews, we systematically searched five databases in July 2024. The eligible studies included adults with brain injuries assessed using either simulators or on-road evaluations. Driving behaviors were categorized as operational, tactical, or strategic.

Results: Thirty-eight studies met the inclusion criteria. Individuals with brain injury who failed the driving assessments (i.e. simulator or on-road) exhibited more frequent tactical-level errors, including lane deviations, and inadequate visual scanning than those with brain injury who passed. Simulator assessments are often used in studies comparing individuals with brain injury with healthy controls, whereas on-road assessments are more commonly used in studies assessing pass/fail outcomes.

Conclusion: Tactical-level errors, such as those involving decision-making and maneuvering in response to traffic, were consistently observed in individuals with brain injury. Assessment tools should prioritize the evaluation of operational and tactical abilities while expanding their capacity to capture strategic-level performance, which remains underassessed.

Objectives: To examine self-reported sport-related concussion (SRC) symptom duration and return to sport (RTS) timelines across countries and sport demographics in a large international cohort.

Methods: An anonymous survey collected sociodemographic data and concussion history from French-speaking athletes affiliated with the ReFORM IOC Research Center. SRC symptoms and RTS durations were analyzed by geographic origin (Canada, Europe) and a multivariate analysis examined the combined impact of geographic origin, sex, age group (minor, adult), professional status (amateur, professional) and SRC risk (low, moderate, high).

Results: Of 998 participants (Canada: 635; Europe: 363), 409 (41%) reported a history of SRC. Median [IQR] symptom duration was longer in Canada (30 [14, 91] days) than Europe (7 [2, 21] days; p < 0.001). RTS was also longer in Canada (28 [14, 61] vs. 10 [7, 21] days; p < 0.001).The binary logistic regression identified geographic origin (Canada) and sex (female) as significant predictors of prolonged symptom duration (i.e. >14 days) and return to sport (i.e. >20 days), while age group, professional status and SRC risk did not significantly influence these durations.

Conclusion: SRC recovery times differ significantly by geography and sex in French-speaking athletes. European athletes and males report shorter symptom and RTS durations.

This case report describes a six year-old boy who was diagnosed as having an accidental firearm injury from a 'tired bullet.' When a shot is fired at a right angle into the sky, the bullet loses its kinetic energy and velocity after a certain distance, then starts to fall and reaccelerate due to gravity. Injuries from free-falling bullets, which are variously referred to as 'tired bullets,' have been on the rise in recent years due to increasing uncontrolled firearm acquisition.

Objective: To determine the long-term efficacy of pediatric Goal Management Training (pGMT) versus pediatric Brain Health Workshop (pBHW) in improving executive function (EF) among adolescents with pediatric-acquired brain injury (pABI).

Method: This study reports a 5-year follow-up of the CORE trial, which included participants aged 10-17 years at baseline, randomized to either pGMT or pBHW. EF was measured at five timepoints using the parent-rated Behavior Rating Inventory of Executive Function (BRIEF), including the Behavior Regulation Index (BRI) and the Metacognition Index (MI). Outcomes were evaluated using linear mixed models (n = 73) and Reliable Change Index (RCI) analyses (n = 34).

Results: Significant improvements over time were observed for both BRI (F_{(4, 65.615)} = 9.64, p < 0.001) and MI (F_{(4, 51.758)} = 4.29, p = 0.004). No significant group differences were detected, indicating that both interventions were associated with comparable long-term trajectories. RCI analyses identified clinically meaningful improvements in 12 participants on the BRI (pGMT, n = 3; pBHW, n = 9) and 20 participants on the MI (pGMT, n = 6; pBHW, n = 11).

Conclusions: Adolescents with pABI showed sustained long-term gains in EF over five years following cognitive rehabilitation, with a notable proportion achieving clinical meaningful improvements. However, given study limitations, results should be interpreted with caution.

Background: Guidelines for sport-related concussion (SRC) management recommend aerobic exercise treatment. Salivary microRNAs (miRNAs) associate with exercise and concussion; therefore, we investigated their expression in adolescents with SRC during prescribed exercise.

Methods: Before and after intervention, athletes with SRC (n = 32, 15.78 ± 1.5 y/o, 66% male, 5.26 ± 3.56 days from injury) and controls (n = 28, 15.96 ± 1.7 y/o, 68% male) provided saliva samples and completed clinical exams. High (5 days/week, 30 min) or low (3 days/week, 20 min) volumes of aerobic exercise were assigned. RT-qPCRs were performed to assess 13 pre-selected miRNAs.

Results: miRNAs 1246, 944, 151a-3p, and 26b-5p were reduced (p = 0.0002, 0.0024, 0.0015, 0.0002, CI mean difference: [-4.55, -1.54] [-4.58, -1.08] [-4.77, -1.24] [-5.64, -1.92], respectively) compared to controls. The expression of 182-5p, 532-3p, and 26b-5p increased with exercise volume in concussed participants (p = 0.0035, 0.0035, 0.0020, CI for exercise coefficient: [0.000100, 0.000396] [0.000060, 0.000237] [0.000107, 0.000373], respectively), but not in controls.

Conclusion: miRNAs 1246, 944, and 151a-3p may be concussion biomarkers unaffected by aerobic exercise. miR-26b-5p, associated with concussion and exercise volume, may be a useful biomarker to monitor adherence to exercise prescriptions for SRC recovery.

Background: Traumatic brain injury (TBI) is one of the leading causes of temporary and permanent disabilities, which requires adequate caregiving for the recovery of TBI survivors. Previous studies have reported that women act as primary and informal caregivers around the world. Since such a caregiving process is influenced by gendered roles and psychosocial factors, developing interventions to address the same is essential.

Methods: The study employed a quasi-experimental single-group intervention design with pre-post-assessments. Fifty women caregivers were recruited using a purposive sampling method. GHQ, Family Burden Scale, and DASS-21 were used as outcome measures.

Results: The study reports a significant improvement in depression, anxiety, and family burden experienced by the caregivers. Mixed results were yielded in the subdomains of general health. Apart from the primary outcomes, the study also helps to understand the lack of informational support experienced by the caregivers and the prevalence of substance abuse among the TBI survivors.

Conclusion: The study reports that psychosocial interventions are effective in addressing the caregiver burden of women caregivers, which indicates that psychiatric social workers should consider providing timely tailor-made psycho-social interventions. The researchers recommend that future studies employ randomized controlled trials to understand the long-term impact of the intervention programs.

Objective: To determine the effects of persistent post-concussion symptoms (PPCS) on neurocognitive, motor, and neurophysiological outcomes compared to healthy controls. Sex-related differences were also examined.

Methods: A cross-sectional design was employed. Fifteen individuals with PPCS (24.3 ± 25.2 months post-injury, 25.7 ± 5.0 years; 9 F) and 15 age- and sex-matched controls (24.4 ± 3.8 years; 9 F) participated in the study. Outcome measures included i) symptom reporting, ii) neurocognitive status, iii) static and dynamic balance, iv) gait, and v) neurophysiology measures of corticospinal excitability and inhibition via transcranial magnetic stimulation.

Results: The PPCS group reported significantly greater number and severity of symptoms compared to the control group (p < 0.001). Overall neurocognitive performance and within the attention domain was worse in the PPCS group (p ≤ 0.04), and females performed worse than males (p ≤ 0.03). Individuals with PPCS had worse performance on gait (p = 0.01), with females in the PPCS group performing the worst (p ≤ 0.04). The PPCS group demonstrated greater corticospinal inhibition compared to controls, but it did not reach statistical significance (p = 0.07, ηp² = 0.22).

Conclusion: The PPCS group demonstrated greater symptom reporting and severity, worse neurocognitive performance, worse balance and gait performance, and altered neurophysiology. Further, females with PPCS demonstrated worse balance and gait performance compared to all other groups.

Objective: This study explored how adolescent peer groups perceive social inclusion of students with Acquired Brain Injuries (ABIs).

Methods: Using the Theory of Planned Behavior (TPB) as a framework, an experimental design used vignettes and questionnaires to examine participants' attitudes, perceived behavioral control, subjective norms, and behavioral intentions toward two fictional students with an ABI - one displaying internalizing behaviors and the other externalizing behaviors. A total of 263 participants aged 11-13 in a large secondary school in the UK participated.

Results: Regression analysis demonstrated that TPB components predicted 83% of the variance in behavioral intentions. Significant differences were reported in all components of TPB based on behavioral presentation, with results demonstrating more positive attitudes, and higher levels of perceived behavioral control toward students with internalizing behavioral presentation following an ABI compared to an externalizing behavioral presentation. Prior experience with ABI was associated with more positive attitudes toward social inclusion.

Conclusions: This research is among the first to explore how behavioral presentation can impact attitudes and behavioral intentions of adolescents toward a fictional student with ABI, providing new theoretical insights into social inclusion. Findings have practical implications for educators and policymakers considering interventions to improve social outcomes following ABI.