Brain injury最新文献

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.

Introduction & objectives: Agitation is a common complication after an acute TBI in ICU patients. Professionals have a range of strategies to address agitation. Yet the absence of evidence-based guidelines and how these strategies are implemented complicates the management and safety may often be compromised for both ICU professionals and patients. This project explores experiences and attitudes of ICU-nurses to better understand the management of agitated behaviors in acute TBI-patients.

Methods: Semi-structured interviews were conducted with 12 ICU-nurses from two Level-1 trauma centers in Canada. The interviews explored experiences and perceptions of managing agitation in critically ill TBI-patients. Interviews were analyzed using thematic analysis, facilitating the examination of how management practices interface with contextual variables and clinical strategies.

Results: Five themes were identified: (1) a variety of symptoms differing according to patient profile and time since awakening, (2) different agitation management approaches stem from different concerns, (3) strategies used by nurses to manage agitation, (4) contextual factors influence management, and (5) potential opportunities to improve integrated care model.

Conclusions: This research describes nurses' perceptions and helps understand management of agitation, by considering underlying contexts and factors affecting TBI-agitated patients management, how ICU itself contributes to agitation and potential areas for improvement.

Introduction: Most survivors of severe acquired brain injuries will have significant long-term disability. During inpatient rehabilitation, families often have expectations of recovery that do not match healthcare professional opinion. This impacts on patient care, service processes, professional-family relations, and wellbeing. This review aimed to understand how family expectations are managed in this setting, and to explore potential areas of improvement.

Method: A scoping review was conducted by searching CINAHL, Medline, EMBASE and Web of Science. Krieger et al's 'Conceptual Building Blocks' provided a framework to analyze the data using a 'best fit' framework synthesis approach.

Results: Twenty-one papers were included in the review. Six sub-themes within three overarching themes were generated, which explored recommendations for effective expectation management. The sub-themes within the 'staff behaviors' theme were 'appropriate information provision,' 'open communication' and 'prioritize family.' Sub-themes within 'system behaviors' were 'cultural change' and 'increased resource.' 'Rehabilitation as a shared process' was the third theme.

Discussion: Misaligned expectations of recovery appear to reflect a range of unmet family needs related to their position within the healthcare hierarchy, professional-family communication, and their involvement in rehabilitation processes. Early identification of family and healthcare professional expectations alongside regular review may prevent misunderstanding and conflict.

Background: Observational studies suggest that alcohol consumption increases the risk of traumatic brain injury (TBI); however, the causality of this association remains unclear.

Objectives: This study aimed to identify which drinking pattern is the primary factor influencing TBI.

Method: Two-sample Mendelian randomization (MR) was used to assess whether drinking patterns (alcohol consumption, abuse, and intake frequency) are causally associated with TBI risk.

Results: MR analysis revealed causal effects of alcohol intake frequency [odds ratio (OR) 0.806, 95% confidence interval (CI): 0.665-0.978, p = 0.028, beta: -0.215, se: 0.098], alcohol drinks per week (OR 1.772, 95% CI: 1.140-2.753, p = 0.011, beta: 0.572, se: 0.225), and alcohol abuse (OR 1.095, 95% CI: 1.006-1.192, p = 0.035, beta: 0.091, se: 0.043) on TBI. Additionally, no causal effect of alcohol consumption (OR 0.730, 95% CI: 0.264-2.025, p = 0.546, beta: -0.314, se: 0.520) or average monthly alcohol intake (OR 1.138, 95% CI: 0.805-1.609, p = 0.463, beta: 0.130, se: 0.177) on TBI was observed. Similarly, the effects of TBI on alcohol intake were statistically non-significant.

Conclusion: Drinking patterns, including alcohol intake frequency and abuse, influence TBI, whereas TBI rarely influences drinking patterns.

Background: Informal caregivers of individuals with acquired brain injury (ABI) often lack adequate preparedness for caregiving. Caregiver burden may reduce preparedness, with anxiety potentially mediating this relationship. However, these associations remain unclear. This study aims to analyze the relationships between caregiver burden, anxiety, and preparedness, and to explore the mediating role of anxiety.

Methods: This study systematically searched seven databases, including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and China Biology Medicine Disc, from inception to June 6, 2024. Meta-analytic structural equation modeling (MASEM) combines concepts of meta-analysis and structural equation modeling (SEM) to integrate correlation or covariance matrices. A summary correlation matrix was estimated using a random-effects model and incorporated into SEM to examine the associations among caregiver burden, anxiety, and preparedness.

Results: 13,610 articles were screened for MASEM analysis, and 27 studies were included. The MASEM results showed significant correlations among the three variables (all p < 0.001). Additionally, anxiety partially mediated the relationship between burden and preparedness (β= -0.147, 95% CI [-0.226, -0.083]).

Conclusions: Research using the MASEM method observed that heightened caregiver burden and anxiety potentially reduce preparedness, with anxiety significantly mediating the relationship between caregiver burden and preparedness.

Introduction: Magnetic resonance imaging (MRI) has revolutionized our capacity to examine brain alterations in traumatic brain injury (TBI). However, little is known about the level of implementation of MRI techniques in clinical practice in TBI and associated obstacles.

Methods: A diverse set of health professionals completed 19 multiple choice and free text survey questions.

Results: Of the 81 respondents, 73.4% reported that they acquire/order MRI scans in TBI patients, and 66% indicated they would prefer MRI be more often used with this cohort. The greatest impediment for MRI usage was scanner availability (57.1%). Less than half of respondents (42.1%) indicated that they perform advanced MRI analysis. Factors such as dedicated experts within the team (44.4%) and user-friendly MRI analysis tools (40.7%), were listed as potentially helpful to implement advanced MRI analyses in clinical practice.

Conclusion: Results suggest a wide variability in the purpose, timing, and composition of the scanning protocol of clinical MRI after TBI. Three recommendations are described to broaden implementation of MRI in clinical practice in TBI: 1) development of a standardized multimodal MRI protocol; 2) future directions for the use of advanced MRI analyses; 3) use of low-field MRI to overcome technical/practical issues with high-field MRI.

The Long-term Impact of Military-relevant Brain Injury Consortium-Military and Tactical Athlete Research Study (LIMBIC MATARS) program established in 2020 is comprised of 22 universities and health systems across the United States. The LIMBIC MATARS Consortium's goal is to increase understanding of the complexities of concussion in collegiate athletes by leveraging extant retrospective and novel prospective data sets through the application of innovative research designs. The manuscripts in this special issue represent findings from clinical data sets based on consensus-derived common data elements collected from the 2015-2016 to 2019-2020 sport seasons that include 1311 cases of collegiate athletes diagnosed with concussion. Using these data, LIMBIC MATARS investigators addressed hypotheses that included (1) factors, including access to athletic trainers, biological sex, and ADHD, that may influence recovery from concussion, (2) predisposing risks associated with reinjury after return-to-sport, such as sport type, and (3) therapeutic targets for intervention including language barriers, physical activity, return-to-learn, and sleep. This commentary introduces the methodology and 10 descriptive studies highlighting initial findings from the Consortium.

Objectives: Evaluate professional rugby players' self-reported perceived understanding of the head injury assessment (HIA) and return to play (RTP) processes and determine factors related to understanding and trust pertaining to these processes.

Methods: An electronic survey measured concepts of interest. A thematic analysis of player understanding was performed, and player statements were coded.

Results: 207 U.S. Major League Rugby (MLR) players participated (26.7 ± 3.4 years). HIA and RTP protocol understanding was not correlated with concussion history (p = 0.41). International rugby experience and trust regarding MLR support of the following protocols and opposing team medical staff practices varied in their relationship to HIA understanding. Trust that all MLR teams follow the same protocols was positively correlated with all HIA questions (ps < 0.03). No HIA questions were correlated with trust in their own team's medical staff. All trust questions were significantly correlated with RTP process understanding. Qualitative analysis identified four HIA- and RTP-related themes: education needs, staffing needs, HIA criticisms, and importance of player safety.

Conclusion: International playing experience and greater trust in the MLR and league stakeholders were associated with greater player understanding of the HIA and RTP protocols. These results provide insight into the importance of educating players on league-specific concussion protocols.

Objective: Evaluate the prevalence and risk factors associated with depression symptoms at 10 years after traumatic brain injury (TBI) and compare with results at 10 weeks and 1 year.

Methods: A large cohort of prospective admissions with TBI were followed up for 10 years. Depression using HADS (Hospital Anxiety and Depression Scale) score > 8 was measured. Several injury and demographic features were examined for association with depression.

Results: Over 4 years, 1130 individuals were recruited of whom 916 attended at 1 year; after 10 years, 552 attended and 210 had died. 154 (17%) of the cohort was lost to follow-up. The prevalence of depression at 10 weeks was 56.3% [95%CI 52.2-60.5], at 1 year was 42.4% [95%CI 38.3-46.5] and 10 years 38.4% [95%CI 34.3-42.5]. There was considerable change in individual scores over time in both directions. A multivariable analysis identified the independent predictors of 10-year depression score as lower GCS, social deprivation, female gender, past psychiatric history, alcohol intoxication and unemployment. Age, ethnicity, social support, TBI etiology, CT abnormality and medical comorbidity were insignificant.

Conclusions: While the overall level of symptoms at 10-year post-TBI remains high, there is considerable change in individual depression status over time. The predictors identified may allow the targeting of vulnerable sub-populations.

Objective: Describe the survival, sociodemographic and clinical characteristics of subjects with disorders of consciousness in a reference rehabilitation center, in a developing country.

Methods: Patients with disorders of consciousness (DoC) caused by acquired neurological injuries, admitted between the years 2002-2018 in a neurorehabilitation center. Extracted data covered demographics, clinical details, survival time, and discharge information. Cox proportional hazard model and Kaplan-Meier analysis were used to reveal, associations with survival.

Result: Out of 5064 neurological cases, 159 patients were diagnosed with DoC. The demographic data showed a male dominance (65%), with an average injury age of 42 years. The most common causes were traumatic (41%), anoxic (36%), and vascular (10%), with traffic accidents accounting for 71% of traumatic injuries. The study found that 75% of patients remained in a vegetative state (VS), and 25% in a minimally conscious state (MCS), with an average survival of 2110 days.

Conclusion: There were no significant differences in survival days between patients in MCS and VS. Patients with traumatic injuries showed a higher survival rate than those with non-traumatic injuries. Age and etiology were identified as factors associated with a higher risk of death.