Brain injury最新文献

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.

Background: Sports participation benefits children but increases the risk of mild traumatic brain injury (mTBI) and orthopedic injury (OI). This study examines risks of mTBI vs. OI associated with specific sports and benefits of sports participation.

Method: This is a cross-sectional study analyzing baseline data from the Adolescent Brain Cognitive Development (ABCD) Study, with a sample of 11,055 children aged 9-10. Generalized linear mixed-effects models were used to examine whether the risks of mTBI and OI differed across individual sports.

Results: Compared to children who had not participated in climbing, those who participated had a higher risk of mTBI than OI (ratio of odds ratio = 1.881, p = 0.013). Sports participation was associated with better behavioral/emotional outcomes, with stronger benefits for mTBI children compared to those with no injury (p = 0.043), but no significant difference between mTBI and OI groups.

Conclusion: Different sports have distinct risks for mTBI and OI in children. Behavioral benefits of sports were more pronounced for children with mTBI than for uninjured children but similar between mTBI and OI groups. While causal connections cannot be established with the current study design, these findings suggest the need for sport-specific and injury-specific strategies to mitigate risks and maximize benefits of youth sports.

Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) is brain damage caused by reduced blood/oxygen supply during the perinatal period. There is no adequate treatment currently. The kinase WNK3 is associated with cerebral edema and stroke prognosis, so we assessed its expression in a neonatal rat model of HIE.

Methods: The Rice method was used to induce HIE in 7-day-old rat pups by ligating the left carotid artery followed by hypoxia exposure. Rats were divided into sham, 6 h, 12 h, 24 h, and 48 h groups (n = 5 each). Neurological function was evaluated by negative geotaxis, righting reflex, and Morris water maze tests. WNK3 expression was measured by Western blotting, RT-PCR, immunohistochemistry, and immunofluorescence in brain samples.

Results: HIE rats showed significant neurological impairments in short and long-term tests compared to shams. Negative geotaxis and righting reflex times were prolonged in HIE rats (all p < 0.01), and Morris water maze performance was impaired at 4 weeks (p < 0.05). Western blotting revealed an approximate three-fold increase in cortical WNK3 protein expression by 48 h post-HIE (p < 0.001), while RT-PCR showed reduced WNK3 mRNA expression with a nadir at 6 h, a partial rebound at 24 h, and a decline again at 48 h. Histological staining confirmed increased proportions of WNK3-positive cells in peri-infarct cortex after HIE (p < 0.001).

Conclusion: Our study demonstrated a dissociation between WNK3 protein (upregulated ~3-fold) and mRNA (downregulated except for a transient 24 h rebound) in neonatal HIE, suggesting post-transcriptional regulation. The WNK3 upregulation may contribute to cerebral edema formation and neurological deficits. These findings are correlative; larger, sex-balanced studies incorporating WNK3 inhibition, direct brain water measurements, and integration with hypothermia therapy are warranted to test WNK3 as a therapeutic target in neonatal HIE.

Objective: Advanced neuroimaging methods have the ability to demonstrate neurobiological factors and detect potential underlying neuropathology associated with mild traumatic brain injury (mTBI), even in the absence of standard, conventional clinical computed tomography (CT) and/or magnetic resonance (MR) imaging (MRI) results.

Methods: This is Part III of a four-part series of critiques about the limitations of traditional neuropsychological methods in the clinical as well as research-based assessment of the mTBI patient.

Results: Part III reviews advanced quantitative image analysis methods used to examine brain structure, neural network integrity and functional connectivity following mTBI. Furthermore, this review demonstrates the relationship between symptom burden following mTBI and detecting underlying neuropathology, where traditional neuropsychological tests may reflect no impairment. Significant neuroimaging associations implicating neurobiological, pathophysiological and neuropathological underpinnings associated with mTBI may be demonstrated where traditional neuropsychological measures may be unrevealing.

Conclusions: Characterizations from traditional neuropsychological measures as independent tests indicating no lasting sequelae from mTBI, especially after three-months post-injury from mTBI need to be viewed within the context of what advanced neuroimaging can demonstrate. Future directions involving the integration of advanced neuroimaging developments applicable to the mTBI patient are reviewed, especially when integrated with neuropsychological methods.

Background: This study investigated the presence and level of alexithymia and examined the relationship between alexithymia and affect recognition abilities after acquired brain injury (ABI), accounting separately for etiology due to stroke or traumatic brain injury (TBI).

Methods: Ninety-nine neurologically healthy adults (NHA) and 119 adults with moderate-to-severe ABI (63 TBI, 56 stroke) participated. Main measures included the Toronto Alexithymia Scale-20 (TAS-20) and Multicultural Facial Emotion Perception Test (MFEPT).

Results: ABI groups endorsed greater alexithymia than NHA, but TBI and stroke subgroups did not significantly differ. Hierarchical multiple regression indicated that TAS-20 subscales difficulty identifying feelings (DIF) and externally oriented thinking (EOT), but not Difficulty Describing Feelings (DDF), added unique value to predicting objective affect recognition (MFEPT) after accounting for age, education, sex, face recognition ability, and general cognitive function. Moreover, the relationship between alexithymia and affect recognition was moderated by group: DIF and DDF were inversely related to MFEPT only for adults with ABI. EOT was inversely related to affect recognition for all three groups.

Conclusions: Adults with ABI experience alexithymia more frequently and intensely than neurologically healthy adults, and this impairment may partly underlie struggles with affective processing frequently observed in these individuals on experimental tasks and in real-world interactions.

Background: Geriatric patients are disproportionately affected by neurocritical conditions including traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), and intracerebral hemorrhage (ICH), yet remain underrepresented in clinical research and guidelines.

Objective: To assess the current state of geriatric-specific research and guideline development in neurocritical care (NCC), and to identify gaps in evidence and recommendations.

Methods: We conducted a structured literature review of original research articles published between 2018 and 2023 that focused on geriatric SAH, ICH, and TBI. Search strategies included key terms applied to Medline with specific inclusion/exclusion criteria. Additionally, we reviewed existing guidelines from major stakeholders including the Neurocritical Care Society and American Geriatrics Society for geriatric relevance.

Results: Of 70 featured NCC articles, 38 addressed SAH, ICH, or TBI. After filtering, 59 geriatric SAH, 218 geriatric TBI, and 63 geriatric ICH studies were identified. Results highlight a growing but insufficient body of geriatric neurotrauma research. Key gaps include the lack of validated risk stratification tools for older patients and a paucity of guideline recommendations specific to geriatric populations.

Conclusions: Despite increased incidence and complexity of neurotrauma in the elderly, current research and guidelines inadequately address geriatric needs. There is a pressing need for multidisciplinary guideline development, frailty-informed protocols, and targeted clinical research.

Purpose: Mild traumatic brain injury (mTBI) is a common injury in youth, and it has been shown to be related to a host of externalizing and internalizing symptoms. The long-term impact of mTBI may be greater for youth from marginalized backgrounds. Additionally, mental health symptoms present prior to the injury may also affect responses to mTBI in youth.

Methods: The current study utilized cross-sectional and longitudinal data from the Project on Human Development in Chicago Neighborhoods (n = 1,785) to assess the potential interactive effects of mTBI, Caregiver education (i.e. a SES proxy), and preexisting psychopathology on post-injury externalizing and internalizing psychopathology.

Results and significance: The three factors interacted to predict post-injury externalizing but not internalizing psychopathology. Youth with lower preexisting mental health symptoms who experienced a mTBI were at greater risk for psychopathology than those with higher pre-injury mental health symptoms and non-injured youth. Lower caregiver education was found to be a risk factor for greater increases in externalizing psychopathology following mTBI in youth. As such, stakeholders should be made aware of the possibilities raised by these findings and seek methods for reducing this disparity in outcomes for marginalized youth.

Objectives: To measure epidemiological data on concussions and examine the association between knowledge and attitudes about concussions and inappropriate post-injury behavior.

Design: Descriptive, cross-sectional study.

Setting: Online survey.

Participants: A total of 365 competitive cyclists in Japan.

Main outcome measures: Survey items included participant information, the experience of concussion-like symptoms, concussion knowledge index (CKI) score, concussion attitude index (CAI) score, and inappropriate behavior post-concussion injury.

Results: The prevalence of concussion-like symptoms among all competitive cyclists was 45.8%. CKI and CAI scores for all participants were 21.7 ± 3.4 and 10.5 ± 3.4, respectively. No significant differences were identified in CKI and CAI scores based on concussion-like symptom experience. After adjusting for covariates, we found that the risk of 'returning to training without rest after injury' decreased by 20% for each 1-point increase in CKI score. In contrast, the risk of 'returning to training with symptoms remaining' decreased by 13% for each 1-point increase in CAI.

Conclusions: An association was found between concussion knowledge and return to competition without a period of rest post-injury, as well as between attitude toward concussion and return to competition with symptoms. Therefore, these findings can contribute to concussion education among cyclists.

Background: The American Board of Medical Specialties recognized brain injury medicine (BIM) as a subspecialty certification for physicians from diverse training backgrounds. Increasing the number of physicians pursuing BIM fellowship training remains imperative given the increasing prevalence of patients with traumatic brain injuries.

Methods: This was a retrospective cohort study of BIM fellowship applicants from 2017 to 2024. The annual volume of available training positions, applications, match rates, and unfilled training positions were calculated.

Results: The annual volume of BIM training programs (16 to 26, 63% increase), training positions (17 to 31, 82% increase), and applicants (16 to 26, 63% increase) increased over the study period (p < 0.001). The annual applicant-to-training position ratio ranged between 0.7-1.2 with no significant change over the study period (p = 0.598). In total, there were 198 available training positions and 39 went unfilled (20%). The rate of unfilled training positions (12% to 16%, p = 0.601) and annual match rates (94%-100%, p = 0.958) did not change. Most applicants matched at their first-choice (45%) or second-choice (16%) fellowship programs.

Conclusions: There were 198 BIM fellowship positions available over the study period and 39 went unfilled (20%). Coordinated efforts may stimulate earlier physician interest in BIM training to meet future demands.