Brain injury最新文献

Objective: The primary objective was to investigate the association between and the predictive value of hippocampal volume on verbal episodic memory (VEM), in participants with chronic moderate-to-severe TBI (MS-TBI).

Method: Nighty-one individuals with MS-TBI (males = 82, females = 9) were included (mean age = 33.57 years; mean educational level = 12.20 years; mean time since injury = 5.16 years). To assess VEM the Immediate Recall 1st Try, AVLT Total, Short and Long Delay Recall and Recognition trials of the Auditory Verbal Learning Test (AVLT) Greek Version, and the Immediate and Delayed Recall tasks from the Logical Memory subtest (Wechsler Memory Scale-III) were implemented. T1-weighted magnetic resonance images were used to extract global volumes and unilateral and bilateral hippocampal volume.

Results: Bilateral hippocampal volume was positively associated with the AVLT Long Delay Recall scores. Also, the left hippocampal volume was positively correlated with the AVLT Long Delay Recall and the LM Delayed Recall scores. Finally, the left hippocampal volume predicted performance on the LM Delayed and the AVLT Long Delay Recall tasks.

Conclusion: These findings suggest a potential role of the hippocampus in VEM performance in chronic MS-TBI and highlight the need for further research to clarify these associations and guide the development of targeted memory interventions.

Objectives: To summarize patient perspectives after participating in a behavioral intervention designed to improve adherence to positive airway pressure therapy in Veterans with traumatic brain injury (TBI) and obstructive sleep apnea. The four-module adherence intervention was based on Motivational Interviewing and Cognitive Behavior Therapy principles and was adapted for persons with cognitive impairments.

Methods: Post-intervention semi-structured interviews were conducted with 13 patients with moderate-to-severe TBI. This qualitative study used a pragmatic and deductive approach with the Health Belief Model as the overarching framework. Two qualitative researchers coded and analyzed data with saturation reached after six interviews.

Results: The sample mean age was 51.4 years (SD = 10.8), who were on average 9.4 years post-TBI (SD = 10.1) and 6.8 years (SD = 5.1) post-OSA diagnosis. Patient feedback was organized into four themes that aligned with the Health Belief Model and two themes pertaining to logistics.

Conclusions: Participation in this adherence intervention was associated with increased awareness of OSA severity, its impact on them, and treatment benefits. Future research should examine the effectiveness of the intervention in real world clinical settings and obtain consumer input from treating clinicians to optimize the program and patient health and functioning.

Background: Acute neck pain following a concussion has been identified as a symptom associated with a delay in symptom resolution and persistent post-concussion symptoms (PPCS), but little is known about the relationship between the presence of acute neck pain and other known risk factors of delayed return to play (RTP) such as sex, sport contact level, and race.

Methods: This study reports the findings of a secondary data analysis of a prospective cohort study sample from the Concussion Assessment, Research, and Education (CARE) Consortium. We examined the possible mediating effects of neck pain severity on known factors of delayed RTP (sex, sport contact level, and race) following a suspected concussion.

Results: While neck pain was identified as significant predictor of delayed RTP (b = .046, S.E.  = .021, Wald χ²(1) = 4.745, p = 0.029), no interaction effect was observed between neck pain and the explored mediating factors of sex, sport contact level, and race.

Conclusions: These results suggest that independent of an individual's sex, sport contact level, and/or race, the presence of neck pain following a suspected concussion should be further evaluated and differentially diagnosed to rule out comorbid pathologies that may be contributing to PPCS following a suspected concussion.

Objectives: This study aims to find the incidence of pulmonary embolism (PE) in traumatic brain injury (TBI) and the impact of comorbidities on the development of PE in the United States.

Methods: This is a retrospective study of inpatient subjects from 2016 to 2020 in the United Stateswith TBI collected from the Healthcare Cost and Utilization Project (HCUP). Patients were evaluated for demographics, types of TBI, comorbidities, and complications. Regression statistical analyses were conducted to find the odds of developing PE after TBI.

Results: 219,005 TBI cases were included, of which 1,367 developed PE (0.6%). The cohort was mostly white (71%), and males (60%), with a mean age of 61.75 y/o. The patients who developed PE were younger (60.36 vs. 61.76, p < 0.001), had longer hospital stays (18.6 vs. 6.8 days, p < 0.001), and had significantly higher mortality (14% vs. 8%, p < 0.001). In multivariate analysis, having lower DVT (OR 10.16 [9.07-11.39], p < 0.001), upper DVT (OR 2.78 [2.26-3.42], p < 0.001), pneumonia (OR 1.35 [1.21-1.51], p < 0.001), myocardial infarction (OR 1.28 [1.00-1.63], p = 0.049), and sepsis (OR 1.26 [1.08-1.48], p = 0.004), had the highest association with developing PE following TBI.

Conclusions: Our data show that the incidence of PE in TBI patients is low; however, it is lethal with longer hospital stay. The risk of PE is higher in those with comorbidities such as paralysis, AIDS/HIV, metastatic cancer, and fluid/electrolyte disorders.

Introduction: Prolonged disorders of consciousness (pDoC) patients require specialized care to support recovery and manage complications, but information regarding the location and scope of dedicated centers is lacking. We conducted an international survey among specialists in this field to identify centers serving this population and developed a publicly available online resource for care providers, families, stakeholders, and neuroscientists involved in the care and management of people with pDoC.

Methods: A 17-question survey was distributed online between May 2022 and May 2024 to IBIA (International Brain Injury Association) members and sent to other professional societies involved in pDoC care. Responses were then grouped and analyzed based on geographic regions (Europe/UK, USA, and others).

Results: We collected data from 153 centers across 35 countries. Most centers indicated they accepted patients of all etiologies and ages, with regional differences in length of stay, access pathways, and discharge criteria. Nearly all centers were reported to provide caregiver training and counseling. A link to the map with centers contact information had been published on the IBIA website (https://www.internationalbrain.org/membership/ibia-special-interest-groups/disorders-of-consciousness-special-interest-group/disorders-of-consciousness-programs-project).

Discussion and conclusions: Our survey allowed the creation of the first preliminary international map of centers specialized in pDoC available online to families and providers. Future efforts are needed to identify other relevant centers of care, increase geographical representation, and foster collaboration to improve care accessibility and outcomes for patients with pDoC.

Objective: The acute effects of concussion and head impacts in collegiate student-athletes have been characterized, but not the effects at career end. We investigated how lifetime concussion history, sport contact exposure, and years of primary sport participation (YoP) associate with collegiate student-athlete health at institutional-exit.

Methods: Collegiate student-athletes (n = 3,663) enrolled in the CARE Consortium cohort study completed eight assessments within 1 year of institutional-exit spanning physical/behavioral, mental and cognitive health, and neurobehavioral symptoms. Separate multivariable linear regressions assessed how sport contact exposure, concussion history (number), and YoP influence questionnaire scores, adjusting for sex, Race, and self-reported athlete-identity and resiliency scores.

Results: Concussion history was associated with adverse scores within certain physical/behavioral, mental, and symptom health. Contact-exposed student-athletes reported improved scores on some cognitive, mental, and symptom health assessments. Greater YoP was associated with improved scores on two mental health questionnaires.

Conclusions: Lifetime concussion history is associated with self-reported health outcomes at institutional-exit, though small effect sizes suggest limited clinical consequence. Higher contact-exposure sports and increased YoP were associated with improved scores on some clinical measures. Further longitudinal monitoring is encouraged to evaluate health-related changes over time, to support student-athletes as they transition out of collegiate sports.

Introduction: Persistent concussion symptoms (PCS) after mild traumatic brain injury (mTBI) interfere with daily functioning. The study aimed to replicate findings of our previous work showing the efficacy of an intensive exposure therapy for PCS.

Method: A replication was conducted with four participants (age M = 25.5, time-since-injury M = 13.25), using a multiple-baseline multi-phase (A-B-C-D-E) single-case experimental design. A randomly assigned baseline (A) preceded the 4-week exposure intervention (B - exploration, C - active exposure, D - booster) conducted by psychologists, with a 4-week follow-up (E). The primary measures, including active avoidance, believability, satisfaction, and symptom experience, were assessed daily on visual analogue scales. Secondary measures of symptom severity, catastrophizing, activity avoidance, anxiety, depression, societal participation and therapeutic alliance were measured across four time points.

Results: Significant effects were shown in visual and Tau-U analysis for all participants on all primary measures comparing baseline and intervention phases. For all primary measures, the pooled standardized mean difference (PSMD) was high. Clear improvements were seen on all secondary measures except anxiety.

Conclusions: The findings of this study further confirmed the efficacy for this intensive exposure therapy for PCS, adding further evidence for exposure therapy in this patient population. Replication in other samples is needed.

Objective: To explore the survival time of adult chronic patients with Disorders of Consciousness (DOC).

Methods: We retrospectively considered 244 chronic DOC patients in 14 long-term care (LTC) facilities from 2017 to 2020. We considered patients' demographics (age, sex) and clinical (etiology, Body Mass Index) variables to explore any difference in survival probabilities. For longitudinal descriptive purposes, time from acute events and total scores at different clinical scales addressing patients' level of consciousness and disability were also considered.

Results: At the end of the 3-year follow-up period, 136 patients out of 244 died. The median overall survival was 67.6 months from the acute event, with significantly longer survival for younger patients and patients with traumatic etiology. However, almost all traumatic patients fall into the youngest patients' group.

Conclusion: During LTC hospitalization, chronic DOC patients showed a high level of disability and their clinical profile remained stable unless comorbidities or clinical complications arose. Age at the acute event is the main factor explaining survival probability, while the role of etiology, an already-known relevant factor for prognosis in the acute and post-acute phases, might be secondary in the chronic phase.

Objective: To investigate the presence of specific family functioning trajectories in the 7-10 years after pediatric traumatic brain injury (TBI) and explore predictors associated with these trajectories.

Methods: One hundred and thirty-seven families of children aged 1-12 years who experienced traumatic brain injury were prospectively recruited from a single site, statewide tertiary pediatric hospital. Assessments of family functioning were undertaken using the Intimacy, Conflict and Parenting Style: Family Functioning Scale at preinjury, 6-months, 12-months, 30-months, and 7-10 years. Group-based trajectory modeling was used to identify latent trajectories of functioning. Associations with child, family, and injury characteristics were explored.

Results: We identified four distinct family intimacy profiles, four conflict profiles, and three parenting style profiles. Profiles were characterized by their level of functioning, which remained mostly stable from pre-injury levels across the 7-10 years post-injury. Trajectory membership was not reliably related to characteristics of the child, family, or injury.

Conclusions: These findings suggest that, while families operate at different levels of intimacy, conflict, and parenting flexibility, these do not change after a child's TBI. Given the established role of family functioning in shaping recovery outcomes, assessments of pre-injury family functioning may enable identification of families with children at risk for poorer outcomes post-TBI.

Objective: To investigate if colored overlays influences reading performance in adults with an acquired brain injury (ABI).

Methods: An experimental cross-sectional study where patients with ABI and reading-related visual discomfort (n = 25) were recruited from an outpatient rehabilitation clinic. Reading speed with and without colored overlays was investigated using the Wilkins Rate of Reading Test (WRRT) and coherent text. Eye movements were recorded with the Readalyzer. The Visual Discomfort Scale (VDS) was used for symptom assessment.

Results: Reading of WRRT was faster with an overlay (3.9%, p = 0.04). Participants with lower baseline reading speed (without overlay) showed greater improvements when reading the WRRT (median increase 10.9, 4.6-67.0%) and coherent text (median increase17.5, 5.5-93.2%). Improvements were reflected in significantly fewer progressive and regressive saccades, and shorter fixation durations. Improvements in reading speed correlated positively with VDS score (p = 0.05).

Conclusions: The findings support the theory that colored overlays can facilitate reading in some patients. Possible mechanisms are discussed in relation to reading ability, visual, and cognitive functions. Further research will be needed to increase the understanding of sensory visual stress and the effect of colored overlays in the ABI population.