Brain injury最新文献

Objective: Despite indications that patients with Acquired Brain Injury (ABI) as a result of deliberate self-harm have more complex presentations and lower rehabilitation outcomes (Brenner, 2009)¹, there is nominal published literature that considers adjustments to care for these individuals. A multifaceted and emotionally triggering subject, laced with clinical and ethical considerations, the lack of published articles may indicate the complexities surrounding this topic.

Method: This case study reflects on the care of a young man on a specialist brain injury unit who had devastating physical and cognitive disabilities after a significant drug overdose. Because the patient was unable to make informed treatment choices, all medical care was delivered in the patient's best interest amidst questions and doubts about the value of continuing life-saving treatments and escalation plans.

Results: This article is not to defend or challenge the decisions made during this patient's care, but reflects on the complexity and impact of these situations on the patient, the family, and the care team. The patient's father gave permission for this case review publication.

Conclusion: Further investigation is needed to better understand the challenges faced by this population and to determine if bespoke pathways and therapy considerations are necessary to address these specific circumstances.

Background: Impaired self-awareness (ISA) is common in individuals with an acquired brain injury (ABI) and can lead to reduced awareness of one's difficulties. Previous reviews have found that ISA impacts on functional outcomes in rehabilitation. However, to date there has not been a systematic literature review which examines how ISA impacts on the process of rehabilitation in ABI populations.

Method: A literature search was conducted using several databases in May 2024, including Academic Search Premier, CINAHL, MEDLINE, APA PsycARTICLES and APA PsycINFO. Seventeen articles were selected for the review and were analyzed using Narrative Synthesis.

Results: Four themes arose from the findings, including goal setting, treatment adherence, engagement and willingness to change and time spent in hospital. ISA was found to impact on the value adult ABI participants placed in rehabilitation, which decreased treatment compliance, motivation, and engagement. ISA also impacted on goal setting and behavior and resulted in a longer length of time spent in hospital.

Conclusion: This review emphasizes the impact of ISA on various aspects/processes of rehabilitation in ABI and provides considerations of how clinicians might adapt interventions to manage these difficulties.

Objective: This study explores the relationship between PTSD symptoms and cognition in patients with persistent post-concussive symptoms (PPCS).

Methods: Adults with PPCS presenting to a specialized brain injury clinic provided demographic and injury information and completed the PTSD checklist for DSM-5, Generalized Anxiety Disorder Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). The Montreal Cognitive Assessment (MoCA) was used to screen for possible cognitive concerns. Multiple regression analysis (MLR) adjusting for age, sex, mechanism of injury, psychiatric history, number of previous concussions, months since most recent injury, and mental health questionnaire scores was used to determine associations between PTSD and cognition. Binomial logistic regression explored the relationship between domains of the MoCA and PCL-5 scores.

Results: We found a negative correlation between MoCA scores, PCL-5 (ρ=-0.211, p = 0.009) and PHQ-9 (ρ=-0.187, p = 0.021) in patients with PPCS and collinearity of PCL-5 and PHQ-9 scores. Significantly higher Arousal and Reactivity cluster scores within the PCL-5 were associated with poorer scores on naming and abstract tasks on the MoCA.

Conclusion: The association between specific PCL-5 clusters and lower MoCA scores may represent a viable target for psychotherapeutic and psychopharmacologic intervention in patients with cognitive changes associated with PPCS.

Objective: To examine agreement between parental reports of head injury and evidence of head injury in medical records and to compare these two measures in predicting early conduct disorder (CD).

Design and setting: Parent survey data was compared with records of child head injury from the National Health Services Register (Régie de l'assurance maladie du Québec, RAMQ) administrative database.

Participants: Children (N = 685) ages 6-9 with and without CD. There were 147 children with RAMQ recorded head injury and 39 children with parent-reported head injury.

Main measures: Indication of one or more head injury before 6 years of age as reported by parents and/or as noted in medical data. Early CD (present by age 9) according to parents and/or teachers.

Results: Results indicated poor agreement between the two forms of reporting κ = .161 (95% CI, .083 to .239), p < 0.001. Medical data significantly predicted the presence of CD in children, with a RAMQ coded head injury suggesting a child was 1.88 times more likely to have CD. Parent reports of head injuries did not significantly predict CD. Conclusion: Medical data should be prioritized in research addressing pediatric head injury, given that parent reports may fail to capture incidence of injury and therefore may be less predictive of other known correlates of head injury.

Primary objective: To evaluate the accuracy of an innovative machine-learning-powered near-infrared spectroscopy (mNIRS)-based bio-optical sensitivity parameters, namely specific tissue optical index (STOI) and intracranial tissue optical index (ITOI) for effective triaging of patients with suspected traumatic brain injury (TBI) across different age-groups to facilitate timely intervention and curtail the silent epidemic.

Research design: Prospective, observational, double-blinded, cross-sectional single-center.

Methods: A total of 240 subjects suspected with TBI and recommended for head CT scan were enrolled. Findings of CT were compared with the bio-optical sensitivity parameters (STOI+ITOI) generated by the mNIRS system to detect intracranial hemorrhages (ICHs).

Statistical software used: spss (ibm version 21.0) results: Bio-optical sensitivity parameters (STOI+ITOI) analysis of 1288 scanned lobes showed high specificity of 97% (CI 95-98%), sensitivity of 96% (CI 92-99%), and accuracy of 97% (CI 96-98%) across all ages, maintaining robust performance for detecting subdural, epidural, subarachnoid hemorrhages, and contusions. Also, the reliability in the diagnosis of ICH was evidenced by Youden's index of 0.93 and positive and negative likelihood ratios of 29.13 and 0.04, respectively.

Conclusion: The mNIRS-based STOI+ITOI proves to be an effective triage tool for TBI, exhibiting superior diagnostic performance across all age-groups.

Background: Despite well-documented benefits of physical activity (PA), people with brain injury face numerous PA barriers. This mixed methods systematic review aimed to summarize barriers and enablers that individuals with traumatic brain injury (TBI) experience when participating in PA.

Methods: Primary studies investigating barriers and/or enablers to PA in adults living with TBI were included. Literature search in MEDLINE, EmCare, Embase, PsychINFO, PEDro, and OTSeeker was initially conducted in December 2021 and January 2022, and updated in June 2022. Methodological quality of the included studies was assessed using Joanna Briggs Institute critical appraisal tools. A customized data extraction form was utilized. Descriptive synthesis was used to summarize the findings.

Results: Twelve studies of various methodological qualities were identified. Barriers to PA included personal issues, changing health status, external factors, lack of support, and lack of knowledge. Identified enablers included personal drivers, social support, professional support, accessibility, and education.

Conclusions: The shared similarities between barriers and enablers across several themes suggest that multiple barriers may be amenable to change. Given the diverse barriers to PA, health professionals should use person-centered, holistic approach with ongoing review and monitoring, when engaging with individuals with TBI.

Background: With the increasing cases of TBI cases in the elderly population taking anticoagulants for comorbidities, there is a need to better understand the safety of new anticoagulants and how to manage anticoagulated TBI patients.

Methods: A meta-analysis using a random-effect model was conducted to compare the effect of preinjury use of DOACs and VKAs on the outcomes following TBI.

Results: From 1951 studies, 49 studies with a total sample size of 15,180 met our inclusion criteria. Our meta-analysis showed no difference between preinjury use of DOACs or VKAs on ICH progression, in-hospital delayed ICH, delayed ICH at follow-up, and in-hospital mortality, but using DOACs was associated with a lower risk of immediate ICH (OR = 0.58; 95% CI = [0.42; 0.79]; p < 0.01) and neurosurgical interventions (OR = 0.59; 95% CI = [0.42; 0.82]; p < 0.01) compared to VKAs. Moreover, patients on DOACs experienced shorter length of stay in the hospital than those on VKAs (OR = -0.42; 95% CI = [-0.78; -0.07]; p = 0.02).

Conclusion: We found a lower risk of immediate ICH and surgical interventions as well as a shorter hospital stay in patients receiving DOACs compared to VKA users before the head injury.

Purpose: To examine how post-concussion changes to the N200 and P300 event-related potentials (ERPs) are associated with cognitive symptoms and neurocognitive performance.

Methods: High-density electroencephalography (EEG) was recorded during a Go/No-Go task from 16 young adults within one month after their concussion and 16 matched controls. Participants were also administered the Cognitive-Linguistic Quick Test (CLQT) and self-reported concussion-like symptoms. Mixed analysis of variance models compared the N200/P300 ERPs between concussion and control groups. Nested linear regressions examined associations between the N200/P300 ERPs and CLQT cognitive domains, cognitive symptom clusters, and total concussion symptoms, with particular interest in within-task changes in the N200/P300 ERPs (e.g. habituation).

Results: N200 and P300 ERP amplitudes were associated with individual differences in cognitive outcomes after concussion. For concussion participants only, smaller P300 amplitudes were significantly associated with greater cognitive symptoms. When considering within-task changes in ERPs over repeated trial presentations, reduced habituation of N200 amplitudes was significantly associated with poorer attention and memory CLQT domain scores. Reduced habituation of P300 amplitudes was also associated with greater cognitive symptoms and total symptoms for concussion participants.

Conclusion: Within-task changes in ERP dynamics supporting attention and executive control are associated with individual differences in cognitive outcomes after concussion.

Objective: The purpose of this study was to explore the experiences of patients and healthcare professionals participating in a randomized feasibility trial exploring the management of acute post-traumatic benign paroxysmal positional vertigo (BPPV), and to establish the acceptability and tolerability of BPPV assessment and treatment procedures.

Methods: This was a multi-center qualitative study nested within a wider randomized feasibility trial. Purposive sampling was used to gather a cohort of healthcare professionals and patients from three major trauma centres in London, UK. Data were gathered using semi-structured interviews and were analyzed using Framework analysis.

Results: Fifteen healthcare professionals and 26 patients participated. Patients and healthcare professionals reported acute BPPV diagnosis was acceptable and practicable. However, divergence was noted regarding views of randomization. Participants proposed several research delivery and protocol modifications for a future trial, including changes to study design and outcome measures.

Conclusions: Healthcare professionals and patients participating in a multi-center qualitative study felt post-traumatic BPPV was feasible and acceptable to diagnose and treat acutely. Findings from this study will enhance the content and delivery of a future trial and may assist in influencing the development of clinical practice guidelines.

Background: Bone marrow mesenchymal stem cells (BM-MSCs) transplantation shows promise for treating ischemic stroke, but the ischemic environment that follows cerebral infarction hinders the survival of transplanted cells. We aimed to study the effects of puerarin (Pue) in combination with BM-MSCs on cerebral ischemic injury.

Methods: After middle cerebral artery occlusion (MCAO) models were prepared by suture-occluded method, rats were randomly allocated to the sham, MCAO, Pue (50 mg/kg), BM-MSCs (2×106), and BM-MSCs+Pue groups. The neurological function, infarct area, levels of inflammation-related factors, brain tissue damage, apoptosis, BrdU, Beclin1, and LC3 levels were then assessed.

Results: Pue and BM-MSCs reduced the modified neurological severity score, cerebral infarction area, and serum inflammation-related factor levels for MCAO rats. Furthermore, Pue and BM-MSCs interventions ameliorated brain tissue damage, and repressed apoptosis of brain tissues in MCAO rats. Moreover, Pue or BM-MSCs enhanced BrdU expression, restrained LC3II/LC3I ratio and Beclin 1 expression in MCAO rats' brain tissues. Importantly, the combination of Pue and BM-MSCs exhibited more pronounced effects on aforementioned outcomes.

Conclusion: The combination of Pue and BM-MSCs facilitated the recovery of neurological function in rats after cerebral ischemic damage, and the mechanisms may correlate with the repression of neuronal apoptosis, inflammation, and autophagy.