Brain injury最新文献

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.

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.

Introduction: Sialorrhea may be a consequence of severe acquired brain injury (ABI). Salivary gland botulinum neurotoxin (SG-BoNT) injections can reduce saliva production, but there is limited evidence for their use in ABI.We reviewed the effectiveness, impact on chest infection frequency, and safety of SG-BoNT for sialorrhea in a cohort of patients with severe ABI.

Materials/methods: Retrospective cohort study of 49 patients, in a specialist ABI care facility, with sialorrhea who received SG-BoNT.Outcome measures included pre- and post-injection Drooling Severity and Frequency Scale (DSFS) scores, pre- and post-injection chest infection frequency, and adverse events.

Results: Forty-nine patients received 79 SG-BoNT treatments (100 to 200 units of botulinum toxin A).Post-treatment the whole group showed significantly reduced mean DSFS scores (z = -6.4, p < 0.00001) and significantly fewer chest infections (z = -3.15, p = 0.0016). A reduction in chest infection frequency was seen in patients who received repeated treatments (2 or more) and/or higher SG-BoNT doses. There were no adverse events.

Conclusions: There is limited evidence for SG-BoNT in the treatment of sialorrhea for people with ABI but this treatment is clinically effective with no detectable adverse effects in this cohort. The reduction in chest infection frequency following repeated SG-BoNT injections is an important novel finding.

Importance: GAAB Syndrome was recently discovered and coined by Rodríguez, Azariah, Ritter, et al.. (2024). It is characterized by bifrontal brain injury, visual pathway damage involving bilateral enucleation, generalized and visual anosognosia and lack of emotional processing with visual anosognosia being more prominent in the clinical presentation of the patient given the context of bilateral enucleation. The syndrome was not explained by delirium nor by amnesia, not either by multiple shunt adjustments or psychological denial.

Objective: To describe the clinical presentation and syndrome length of the patient one year after injury. Results show that most of the syndrome symptoms are resolved after nine months, with just visual anosognosia not resolving completely. The patient improved cognitively as shown by the same tests one year later.

Background: Case management (CM) aims to facilitate access to and integration of health care and social services. We investigated the feasibility and effectiveness of CM.

Methods: Randomized controlled trial with 219 patients and 114 caregivers randomly allocated to CM (109/59) or care as usual (110/55). CM was based on early and continuous online monitoring of problems and needs. Outcomes were assessed every 6 months with the Hospital Anxiety and Depression Scale (HADS). Secondary outcome domains were participant restrictions, life satisfaction, self-efficacy, caregiver burden, and needs. Multilevel modeling was used. Feasibility aspects were protocol delivery, participants' and case managers' satisfaction, and factors affecting implementation.

Results: There were no significant differences between groups. Participation restrictions and unmet needs decreased in both groups within 6 months. Monitoring was successful in 38, and 10 participants asked the CM for support. CM consisted mostly of providing information.

Discussion: CM based on early and continuous online monitoring does not have benefit in identifying and addressing problems early after relatively mild injury. Unsuccessful monitoring may have hindered access to the case manager and prevented us from evaluating CM as a complex intervention. It remains a challenge to early identify those who could benefit from care coordination.

Objective: Mild traumatic brain injury (mTBI) is frequently overlooked in polytrauma patients due to the overshadowing of more severe injuries, a fact that makes its identification in post-acute settings challenging since symptoms overlap with other conditions and no validated diagnostic tools exist. To address this gap, this scoping review explored the literature on mTBI diagnosis in post-acute civilian polytrauma settings.

Methods: By utilizing the Arksey and O'Malley framework and PRISMA-ScR guidelines, the review focused on studies from 2010 to 2024 related to delayed mTBI diagnosis in adults. Of the 696 studies identified, only six met the inclusion criteria, highlighting the limited research in this area.

Results: The review assessed various diagnostic tools including the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), neuropsychological tests, advanced imaging, and oculomotor assessments. However, these tools are limited in their ability to confirm whether an mTBI has occurred. The American Congress of Rehabilitation Medicine's updated mTBI criteria may offer the best diagnostic potential but require validation.

Conclusion: According to the findings, there is a significant gap in validated diagnostic tools for mTBI in post-acute settings, which may negatively affect patient outcomes. Developing and validating effective screening tools for mTBI in the post-acute polytrauma setting should be the priority of future research in this area.

Objective: This study aimed to identify Dizziness-Related Disability (DRD) recovery trajectories in pediatric concussion and assess clinical predictors of disability groups.

Materials and methods: In this prospective cohort study, 81 children (8-17 years) diagnosed with an acute concussion took part in 3 evaluation sessions (baseline, 3-month, and 6-month). All sessions included the primary disability outcome, the Dizziness Handicap Inventory (DHI) to create the DRD recovery trajectories using group-based multi-trajectory modeling analysis. Each independent variable included general patients' characteristics, premorbid conditions, function and symptoms questionnaires, and clinical physical measures; and were compared between the trajectories with logistic regression models.

Results: Low DRD (LD) trajectory (n = 64, 79%), and a High DRD (HD) trajectory (n = 17, 21%) were identified. The Predicting and Preventing Postconcussive Problems in Pediatrics (5P) total score (Odds Ratio (OR):1.50, 95% Confidence Interval (CI): 1.01-2.22), self-reported neck pain (OR:7.25, 95%CI: 1.24-42.36), and premorbid anxiety (OR:7.25, 95%CI: 1.24-42.36) were the strongest predictors of belonging to HD group.

Conclusions: Neck pain, premorbid anxiety, and the 5P score should be considered initially in clinical practice as to predict DRD at 3 and 6-month. Further research is needed to refine predictions and enhance personalized treatment strategies for pediatric concussion.

Objectives: To explore the rates and timing of a first follow-up visit for children and adolescents with a concussive injury and to identify factors associated with follow-up timing.

Methods: A descriptive, correlational design drawing on linked, population-based administrative data of concussed children and adolescents (ages 5-18 years) from the province of British Columbia (BC), Canada. Data were accessed through Population Data BC. Descriptive statistics and binary logistic regression were used to analyze the data.

Results: From January 1, 2016 to December 31, 2017, we retrieved 22,601 cases of concussion, of which 19% had an early follow-up visit (N = 4,294), 4.9% had later follow-up (N = 1,107), and 76.1% had no follow-up (N = 17,200). The factors of older age, living in a rural area, higher socioeconomic status, and seeing a specialist physician at an initial concussion diagnosis were more likely to have an early follow-up visit.

Conclusion: Early follow-up is important for recovery, but most children and adolescents with a concussion do not receive follow-up in BC.

Introduction: Diagnosis, assessment, and management of sports-related concussion require a multi-modal approach. Yet, currently, an objective assessment of auditory processing is not included. The auditory system is uniquely complex, relying on exquisite temporal precision to integrate signals across many synapses, connected by long axons. Given this complexity and precision, together with the fact that axons are highly susceptible to damage from mechanical force, we hypothesize that auditory processing is susceptible to concussive injury.

Methods: We measured the frequency-following response (FFR), a scalp-recorded evoked potential that assesses processing of complex sound features, including pitch and phonetic identity. FFRs were obtained on male Division I Collegiate football players prior to contact practice to determine a pre-season baseline of auditory processing abilities, and again after sustaining a sports-related concussion. We predicted that concussion would decrease pitch and phonetic processing relative to the student-athlete's preseason baseline.

Results: We found that pitch and phonetic encoding was smaller post-concussion. Student-athletes who sustained a second concussion showed similar declines after each injury.

Conclusions: Auditory processing should be included in the multimodal assessment of sports-related concussion. Future studies that extend this work to other sports, other injuries (e.g. blast exposure), and to female athletes are needed.