Brain injury最新文献

Introduction: Concussions pose a serious threat to adolescents, with potential long-term effects. This systematic review considers whether cardiac autonomic nervous system dysfunction occurs post-concussion in adolescents.

Methods: Eight databases were searched on 30/5/24 using terms related to adolescents, concussion, and the cardiac autonomic nervous system. Included were full-text English articles comparing heart rate, blood pressure, or heart rate variability among adolescents with concussion history and controls. JBI critical appraisal tools assessed methodological quality. Meta-analysis was not performed due to inter-study methodological variations.

Results: Ten studies met the inclusion criteria. Two studies included participants with longer-term concussion histories. Eight studies involved exertion. Mixed results were found for all metrics. A greater percentage of results was significant during exertion; the lowest percentage was for resting heart rate variability (15%), whilst the highest was for heart rate under exertion (46.15%). Critical appraisal highlights methodological flaws. Studies often inappropriately manage confounding factors, and some selected controls inappropriately, such as using individuals with a history of concussion as controls.

Discussion: Evidence suggests possible cardiac autonomic dysfunction post-concussion, more apparent under exertion. Methodological limitations prevent definitive conclusions. Future research should better manage confounding factors to determine whether cardiac autonomic assessment can assist concussion diagnosis and management.

Objective: To identify characteristics predictive of ambulation at discharge from inpatient rehabilitation in individuals with a Disorder of Consciousness (DoC) following traumatic brain injury (TBI).

Design: Prospective cohort pilot study.

Setting: Inpatient Rehabilitation Facility (IRF).

Participants: 15 adults (≥18 years) with a DoC after TBI, admitted to IRF within 6 months of injury.

Main outcome measure(s): 'Ambulate 50 feet' task from Inpatient Rehabilitation Facility - Patient Assessment Instrument.

Results: At discharge, 6 participants (40%) were classified as ambulators and 9 (60%) as wheelchair users. The 'ambulators' group had significantly fewer days between injury and admission to IRF (p < 0.001), higher JFK Coma Recovery Scale-Revised (CRS-R) scores at initial evaluation in IRF (p < 0.001), fewer days in IRF (p < 0.001), and faster rates of progress on the CRS-R in first 10 days at IRF (p = 0.047) compared to the 'wheelchair users' group.Both the rate of progress on the CRS-R in the first 10 days of IRF stay (p = 0.023) and days between injury and admission to IRF (p = 0.023) were significant predictors of ambulation at discharge.

Conclusion(s): This study identifies the rate of progress on the CRS-R in the first 10 days of IRF stay as a potential prognostic indicator for ambulation in individuals with DoC after TBI. Additional research with larger samples is warranted.

Purpose: There are unique characteristics of vulnerability among adult patients who experience a concussion and have persistent symptoms suggesting the need to tailor recruitment and retention strategies for this population. We aimed to obtain perspectives from post-concussion patients regarding factors they value to encourage recruitment and support retention, thereby assisting research teams conducting studies on concussion.

Methods: The authors used purposive, nonrandom sampling to identify potential research participants for this exploratory qualitative sub-study. Interview questions were designed using Appreciative Inquiry to gain patient-centered approaches to support recruitment and retention. Transcripts from telephone interviews were analyzed using reflexive thematic analysis.

Results: We identified two main themes: 1) positive change and 2) participant-centered study design. Each main theme had three sub-themes to support recruitment and/or retention. Positive changes included a) meaningful study impact, b) personal contribution counts, and c) gain information, and reassurance. Participant-centered study design included a) convenience, b) accommodation, and c) feeling valued.

Conclusions: Focused efforts in planning to recruit and retain vulnerable populations for research are paramount. Based on our exploratory findings from a limited sample, we offer patient-reported insights to reflect upon the ongoing learning process to optimize recruitment and retention in the field of concussion research.

Purpose: This study examined how demographic factors, health status, and caregiving preparedness influence the quality of life (QoL) of primary caregivers of stroke patients in Taiwan.

Methods: A cross-sectional survey was conducted with 145 caregivers at a central Taiwan hospital. Data were collected using the Caregiving Preparedness Scale (PCS), an 8-item tool assessing readiness in general care, emergency management, and resource access (5-point Likert scale), and the WHOQOL-BREF Taiwan version, a 28-item measure of physical, psychological, social, and environmental QoL.

Results: The average QoL score was 56.5 out of 80, assessed using WHOQOL-BREF. Stepwise regression analysis identified key predictors of QoL, with variance explained by CESD scores (34.9%), caregiving preparedness (19.3%), caregiver age (8.3%), marital status (0.9%), caregiving time (0.8%), employment status (0.7%), patient age (1.2%), and IADL score (2.6%). The reported percentages reflect each factor's contribution to QoL variance.

Conclusions: Support should be prioritized for caregivers with high depression scores, low caregiving preparedness, and socioeconomic vulnerabilities such as unemployment or low household income, to enhance their quality of life. The reported percentages reflect the variance in QoL explained by each predictor in the regression analysis.

Purpose: Our study aimed to investigate the association between initial serum magnesium levels and long-term functional outcomes in patients with TBI, accounting for variations across different age groups.

Methods: This retrospective study included adult patients with TBI and intracranial injury treated at a level-1 trauma hospital. The primary exposure was on serum magnesium levels within 6 hour of emergency department admission. Study outcomes included 6-month mortality and disability, assessed using the Glasgow Outcome Scale (scores 1-3). Multilevel multivariable logistic regression analysis was conducted to determine the relationship between serum magnesium levels and study outcomes, with stratified analysis employed to investigate potential variations based on age groups.

Results: Low magnesium levels were significantly associated with an increased risk of 6-month disability (Odds ratio (OR) 1.80, 95% confidence interval (CI): 1.14-2.68) and 6-month mortality (OR: 1.82, 95% CI: 1.03-2.99). This association remained significant exclusively among younger patients, with ORs of 2.70 (95% CI: 1.21-5.14) for 6-month disability and 2.33 (95%, CI: 1.11-4.49) for 6-month mortality when stratified by age.

Conclusion: Low serum magnesium levels are associated with poorer long-term outcomes in patients with TBI, and this effect is especially pronounced in younger adults (18-64 years). Specifically, younger patients exhibiting hypomagnesemia demonstrated a higher incidence of 6-month disability and mortality. These findings suggest a need to identify the causative links and explore whether correcting serum magnesium levels will improve TBI prognosis across different age groups.

Objective: Acute sleep disturbances after sport-related concussions (SRC) may affect recovery. This study assessed how sleep symptoms impact time to return-to-learn (RTL), symptom resolution (SR), and return-to-play (RTP).

Methods: A retrospective cohort study was conducted at a regional sports concussion center (11/2017-04/2022) with adolescents presenting within 3 days of SRC. Participants were dichotomized based on the presence or absence of 'trouble falling asleep' per the Post-Concussion Symptom Scale (PCSS). Mann-Whitney U tests compared outcomes, and multivariable regressions adjusted for PCSS, sex, age, and migraine or psychological history.

Results: Among 116 athletes, 29 (25%) reported sleep initiation symptoms. Median RTL was 4 days (IQR = 3-10) in those with sleep symptoms versus 3 days (IQR = 2-4, p = 0.005) without. Median SR and RTP times were longer for the sleep initiation symptoms group: 15 days (IQR = 7-27) vs. 8 days (IQR = 3-20, p = 0.024) for SR, and 16 days (IQR = 11-29) vs. 13 days (IQR = 6-21, p = 0.048) for RTP. Sleep initiation symptoms were not independent predictors of recovery, but migraine history predicted longer RTL, and prior concussions predicted longer RTP.

Conclusions: Although not independent predictors, acute sleep initiation symptoms were linked to delayed recovery. Strategies to optimize sleep acutely post-concussion may help facilitate timely recovery and improve outcomes.

Introduction: There is limited evidence regarding the association between traumatic brain injury (TBI) and the emergence of new-onset psychiatric disorders in adolescents. This prospective study analysed psychiatric disorders, quality of life, and emotional and behavioral difficulties in adolescents with TBI and orthopedic trauma at a 6-month follow-up.

Methods: Adolescents with TBI and a control orthopedic trauma group (without a history of psychiatric disorders) were evaluated using both the Strengths and Difficulties Questionnaire and the Paediatric Quality of Life Inventory.

Results: Forty-one adolescents with TBI and 45 with orthopedic injuries were assessed. TBI patients had significantly lower quality of life and higher levels of emotional difficulties. The prevalence of psychiatric disorders was higher in the TBI group (41.5% vs 15.6%). TBI group had higher rates of post-traumatic stress disorder and depression after 6 months. Hospitalization length and GCS scores were correlated with quality of life outcomes. Regression analysis revealed the presence of psychiatric disorders at 6 months was a significant predictor of reduced quality of life.

Conclusion: This study highlights a significant association between TBI and poorer quality of life and mental health outcomes in adolescents. Adolescents with TBI had higher rates of psychiatric disorder, more pronounced emotional difficulties, and a lower quality of life.

Purpose of research: This review explores the therapeutic potential of hyperbaric oxygen therapy (HBOT) in treating neonatal hypoxic-ischemic encephalopathy (HIE), focusing on its mechanisms of action, combination strategies, and current research gaps.

Principal results: HBOT enhances neuroprotection by increasing arterial oxygen content, promoting neural tissue repair, modulating gene expression, and reducing oxidative stress. When combined with therapies such as therapeutic hypothermia, neurotrophic agents, antioxidants, or phenobarbital, HBOT exhibits synergistic effects. Clinical studies have demonstrated superior outcomes with HBOT-hypothermia combinations versus monotherapies. However, current literature lacks stratified analyses based on HIE severity, head-to-head comparisons of combination strategies, and long-term follow-up data. Moreover, most existing reviews focus solely on mechanisms, underrepresenting clinical applications.

Conclusions: HBOT holds promise as a non-invasive adjunct therapy for neonatal HIE, especially in combination with established treatments. Its safety has improved with advances in neonatal care, allowing broader clinical use. Nonetheless, standardized protocols, stratified clinical trials, and molecular-level studies are needed to optimize therapeutic strategies and enhance outcomes in affected infants.

Introduction: In Canada, concussions are common among children aged 3-12 years. Caregivers play a vital role in their child's post-concussion care, highlighting the need for resources tailored to children and caregivers. Although many online pediatric concussion resources exist, their suitability for younger children and caregivers remains unclear.

Objective: To identify and assess the quality, readability, usability, and suitability of online concussion resources for children aged 3-12 years and their caregivers.

Methods: A four-phased systematic search strategy was used and involved: 1) searching Canadian children's hospital websites, 2) applying pre-established inclusion/exclusion criteria, 3) evaluating content quality, and 4) evaluating resources for suitability, readability, and usability.

Results: The search yielded 738 resources.17 met the final criteria. Among these, 82.4% (n = 14) required the ability to read text, 11.8% (n = 2) specified the age of the resource targeted, and 5.9% (n = 1) focused on return to play beyond organized sport.

Conclusions: The identified resources offer accurate concussion information for children and caregivers, but lack specificity for their intended audience and accessibility for nonreaders. Future resources should consider specifying the intended age group, improving accessibility for nonreaders, and including information about important activities for this age group such as returning to active play.