Brain injury最新文献

Objective: In this study, we evaluated the psychometric properties of the Depression Anxiety Stress Scales 21 items (DASS-21) in a mild traumatic brain injury (mTBI) sample.

Method: Treatment-seeking adults (n = 347) were recruited from outpatient rehabilitation services in New Zealand. Dimensionality, reliability, person separation index, and differential item functioning (DIF) of the DASS-21 were examined using Rasch analysis.

Results: Initial analysis of the complete 21-item DASS showed poor overall fit due to problems with individual items. Fit to the Rasch model was excellent when treated as three composite scores. The stress subscale demonstrated adequate model fit, dimensionality and good reliability. For anxiety, fit was not good, reliability was unsatisfactory and DIF was evident on one item. When this item was removed, fit to the model was still inadequate as was reliability. DIF was also evident for depression, but when this item was removed, fit to the model was adequate.

Conclusion: The DASS-21 is a psychometrically sound measure of distress and stress for adults seeking treatment following mTBI. Ordinal to interval score conversion tables are provided to increase the precision of measurement. When assessing depression in a mTBI population, a 6-item depression subscale is recommended. Caution is advised in using the DASS-21 anxiety subscale alone.

Purpose: The purpose of this study was to extend on previous research finding by investigating adverse childhood experiences (ACEs) and brain injury in children younger than 12 years old.

Methods: A total of 58,601 US children under 12 years old were included in the 2020-2021 National Survey of Children's Health, a self-reported national survey administered to caregivers.

Results: ACEs were significantly associated with increased risk for unconfirmed (χ² (55891, 55904) = 141.84, p < 0.001, R² = .03) and confirmed brain injury, χ² (56481, 56494) = 508.28, p < 0.001, R² = .05 when accounting for demographic characteristics. The association between ACEs and brain injury was not contingent on sports involvement; females not involved in sports had the strongest association between ACEs and brain injury (χ² (10938, 10951) = 99.40, p < 0.001, R² = .03) compared to sports-involved females and males. For children under 12 years old with brain injury, the relations between experiencing at least one ACE and health and educational outcomes were significant for all health and educational outcomes (p < 0.001).

Conclusions: Caregiver education on and screening for brain injury in families experiencing ACEs would likely support more timely identification and management of co-occurring brain injury in this population. Further research is needed to identify prevention, assessment, and management strategies that would be specifically beneficial to children at risk for co-occurring brain injury and ACEs to improve health and educational outcomes.

Purpose: We conducted a proof-of-concept study to evaluate the effects of galantamine treatment versus placebo combined to cognitive rehabilitation (CR) after stroke.

Materials and methods: In this 12-week, double blinded, randomized, controlled trial, patients were assigned to either combined approach of galantamine and CR (G-CR) or placebo and CR (P-CR). Primary outcome was the proportion of patients who crossed over from vascular cognitive disorder (VCD) to no-VCD at 12 weeks. Secondary outcomes included changes in cognition, mood, quality of life and the N-back fMRI paradigm, assessed at baseline, 6 and 12 weeks and after an 8-week washout period.

Results: Ten patients were allocated to G-RC group, 12 to the P-RC group. After 12 weeks, 40.1% of all patients converted to no-VCD with similar proportions between groups. Both groups showed improvements in episodic and working memory, executive and quality of life after 6 weeks of CR. Decreased depression and anxiety were noted, and all benefits persisted after the washout period. An interaction effect was observed in the right parietal lobule during the N-back task.

Conclusions: Interventions lead to improved cognition and distinct cortical reorganization without being able to establish correlation between neural changes and behavioral measures.

Background: Former professional collision sport (CS) athletes, particularly American football players, are at risk of developing chronic health conditions; however, little is known about the health outcomes of amateur athletes.

Methods: A 60-item health survey examined self-reported symptoms and diagnoses among former Division 1 Collegiate CS athletes and non- or limited-contact sport (non-CS) athletes. Binary logistic regressions tested the association between playing CS and health outcomes.

Results: Five hundred and two (6.2%) participants completed the survey: 160 CS athletes (mean age: 59.2, SD = 16.0) and 303 non-CS athletes (mean age: 54.0, SD = 16.9). CS athletes had increased odds of reported cognitive complaints and neuropsychiatric symptoms including memory (P_adj < 0.01), attention/concentration (P_adj = 0.01), problem solving/multi-tasking (P_adj = 0.05), language (P_adj = 0.02), anxiety (P_adj = 0.04), impulsivity (P_adj = 0.02), short-fuse/rage/explosivity (P_adj < 0.001), and violence/aggression (P_adj = 0.02). CS athletes also reported higher rates of sleep apnea (P_adj = 0.02). There were no group differences in cardiovascular and physical health outcomes.

Conclusions: Former CS athletes reported more cognitive and neuropsychiatric complaints. The low response rate is a limitation of this study; however, over 500,000 athletes play college sports each year, thus research on long-term health outcomes in this population is critical.

Objectives: Preliminary examination of emotional awareness/expression relationships with pain in people with traumatic brain injury (TBI) and chronic pain (CP) and exploration of psychological factors as mediators or moderators of these relationships.

Methods: Cross-sectional study in adults (N = 59) with chronic TBI and CP using Toronto Alexithymia Scale-20 Difficulty Identifying and Describing Feelings subscales; Ambivalence over Emotional Expressiveness Questionnaire; Emotional Approach Coping Scale; PROMIS Pain Intensity and Pain Interference scales, Michigan Body Map (pain widespreadness); headache frequency; Pain Catastrophizing Scale; Brief Symptom Inventory-18 (psychological distress), and Post-traumatic Stress Checklist-Civilian.

Results: Difficulty Identifying Feelings was positively associated with pain intensity, pain interference, and headache frequency. Difficulty Describing Feelings was positively correlated with pain interference and headache frequency. Emotional Approach Coping was inversely correlated with headache frequency. Emotional awareness/expression relationships with pain outcomes were mediated by Pain Catastrophizing; Difficulty Describing Feelings relationships with Pain Interference and headache frequency were mediated by psychological distress; and Difficulty Describing Feelings associations with Pain Interference were mediated by post-traumatic stress. No moderators were identified.

Conclusion: These preliminary findings suggest that emotional awareness/expression is linked to pain in adults with TBI and CP, which may be connected via pain catastrophizing and psychological distress. If longitudinal studies with larger samples produce similar findings, researchers should explore training emotional awareness/expression for possible pain management after TBI.

Objective: To examine the relationship between body mass index (BMI), newly developed sleep disorders and functional outcome after moderate-to-severe traumatic brain injury (msTBI).

Methods: Retrospective data from the TBI Model Systems National Database was analyzed, focusing on the independent association between BMI, sleep disorder diagnosis, and functional outcome as measured by the Extended Glasgow Outcome Scale (GOSE) at 1-year post-injury. Linear and logistic regression were used.

Results: Out of 2,142 participants, 84% reported no sleep disorder (NSD), 9% reported a sleep disorder before TBI (PreSD), and 7% developed a sleep disorder after TBI (PostSD). Over 50% of participants were overweight or obese. After adjusting for demographic and clinical characteristics, a one-unit increase of BMI at the time of rehabilitation admission was associated with 3.7% higher odds of PostSD (OR [95%CI]: 1.037 [1.007, 1.068], p = 0.015). PostSD was associated with a 53.6% higher chance of unfavorable GOSE compared to NSD (OR [95%CI]: 1.536 [1.069-2.207], p = 0.02) and an 81.7% higher chance compared to PreSD (OR [95% CI]: 1.817 [1.137-2.905], p = 0.01).

Conclusion: Being overweight/obese and developing a sleep disorder had adverse effects on functional outcome, emphasizing the importance of addressing sleep and lifestyle factors in post-msTBI rehabilitation.

Background: Chronic neurologic deficits from traumatic brain injury (TBI) and subsequent infectious encephalitis are poorly characterized.

Methods: Using TriNetX database we queried patients 18 years or older with a confirmed diagnosis of encephalitis between 2016 and 2024. Patient cohorts included those with a diagnosis of TBI at least one month before encephalitis (N = 1,038), those with a diagnosis of a TBI anytime before encephalitis (N = 1,886), and those with encephalitis but no TBI, (N = 45,210; N = 45,215). A murine model of controlled cortical impact (CCI) injury and Venezuelan equine encephalitis virus (VEEV) infection was used to reflect the clinical model, followed by extracting hippocampal tissue for bulk RNA sequencing and analysis.

Results: Patients with a TBI history at least one month before infectious encephalitis have an increased risk of mortality, epilepsy, and dementia or delirium. Bulk RNA sequencing of the hippocampus from mice subjected to CCI injury and VEEV infection demonstrated that key pathways, specifically those involved in granzyme mediated cell death, were enriched compared to VEEV infection alone.

Conclusion: Our findings reveal that infectious encephalitis in patients with TBI history portends worse neurologic outcomes, and the hippocampus may be vulnerable to granzyme mediated cell death under these conditions.

Background: Despite evidence suggesting perceived stress negatively impacts post-concussion outcomes and that mindfulness may improve that relationship, research has not investigated those connections.

Methods: This cross-sectional, observational study included 80 young adults with a concussion history who completed a single study visit including the following measures: 1) demographics and concussion, mental health, and mindfulness histories; 2) perceived stress [Perceived Stress Scale (PSS-10)]; 3) mindfulness [Five Facet Mindfulness Questionnaire (FFMQ)]; and 4) post-concussion cognitive and mental health outcomes - neurocognitive performance (CNS Vital Signs), psychological symptoms [Brief Symptom Inventory-18 (BSI-18)], and QOL [Patient-Reported Outcomes Measurement Information System (PROMIS®)]. First, separate regression models determined the association among perceived stress and post-concussion cognitive and mental health outcomes. Second, linear regression models determined the association among mindfulness and post-concussion cognitive and mental health outcomes. Third, to test the moderation effect, models included a perceived stress and mindfulness interaction term.

Results: Higher perceived stress was significantly associated with higher psychological symptoms (p < 0.001) and lower QOL (p < 0.05). Higher mindfulness was significantly associated with lower psychological symptoms (p < 0.001) and higher QOL (p < 0.05). No moderation models were significant.

Conclusion: Future research is necessary to further understand mechanisms impacting post-concussion interventions aimed to improve outcomes and life post-concussion.

Background: Aphasia is one of the most common and most debilitating after-effects of a stroke. In the acute phase of a stroke, referrals to speech-language pathology (SLP) are frequently guided by clinical impressions rather than validated tests.

Objectives: This study aimed to evaluate the advantages of incorporating the Screening test for language disorders in adults and the elderly (DTLA) into clinical practice for detecting language disorders during the acute phase of stroke.

Methods: The study includes a retrospective and a prospective component, including a questionnaire on the acceptability, feasibility and usefulness of using the DTLA in patients in the acute phase of stroke.

Results: Sixty-one patients admitted for stroke were recruited for each of the two components. The introduction of the DTLA in the prospective component of the study had a significant impact on the detection of language impairment, as more notes about language were found in patients' medical records and more referrals were made to SLP.

Conclusions: Using a screening test can improve the detection of aphasia during the acute phase of stroke, particularly in patients whose impairments might not be easily identified through subjective assessments.

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.