[Abstract] Cognitive behavior therapy to treat sleep disturbance and fatigue after traumatic brain injury – CNS

OBJECTIVE: To evaluate the efficacy of adapted cognitive behavioral therapy (CBT)
for sleep disturbance and fatigue in individuals with traumatic brain injury
(TBI).
DESIGN: Parallel 2-group randomized controlled trial.
SETTING: Outpatient therapy.
PARTICIPANTS: Adults (N=24) with history of TBI and clinically significant sleep
and/or fatigue complaints were randomly allocated to an 8-session adapted CBT
intervention or a treatment as usual (TAU) condition.
INTERVENTIONS: Cognitive behavior therapy.
MAIN OUTCOME MEASURES: The primary outcome was the Pittsburgh Sleep Quality Index
(PSQI) posttreatment and at 2-month follow-up. Secondary measures included the
Insomnia Severity Index, Fatigue Severity Scale, Brief Fatigue Inventory (BFI),
Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale.
RESULTS: At follow-up, CBT recipients reported better sleep quality than those
receiving TAU (PSQI mean difference, 4.85; 95% confidence interval [CI],
2.56-7.14). Daily fatigue levels were significantly reduced in the CBT group (BFI
difference, 1.54; 95% CI, 0.66-2.42). Secondary improvements were significant for
depression. Large within-group effect sizes were evident across measures (Hedges
g=1.14-1.93), with maintenance of gains 2 months after therapy cessation.
CONCLUSIONS: Adapted CBT produced greater and sustained improvements in sleep,
daily fatigue levels, and depression compared with TAU. These pilot findings
suggest that CBT is a promising treatment for sleep disturbance and fatigue after
TBI.

via Traumatic Brain Injury Resource Guide – Research Reports – Cognitive behavior therapy to treat sleep disturbance and fatigue after traumatic brain injury

[ARTICLE] Pharmacotherapy in rehabilitation of post-acute traumatic brain injury

Brain Research

Available online 20 January 2016

Highlights

• Post-acute TBI has numerous symptoms that require pharmacological management.
• Beta-blockers work well in reducing hyper-arousal in TBI.
• Donepezil can be used to improve cognition and memory after a TBI.
• Melatonin and trazodone can be used to improve sleep after a TBI.
• Sertraline and citalopram can be used to treat depression after a TBI.

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Abstract

There are nearly 1.8 million annual emergency room visits and over 289,000 annual hospitalizations related to traumatic brain injury (TBI).

The goal of this review article is to highlight pharmacotherapies that we often use in the clinic that have been shown to benefit various sequelae of TBI.

We have decided to focus on sequelae that we commonly encounter in our practice in the post-acute phase after a TBI. These symptoms are hyper-arousal, agitation, hypo-arousal, inattention, slow processing speed, memory impairment, sleep disturbance, depression, headaches, spasticity, and paroxysmal sympathetic hyperactivity.

In this review article, the current literature for the pharmacological management of these symptoms are mentioned, including medications that have not had success and some ongoing trials. It is clear that the pharmacological management specific to those with TBI is often based on small studies and that often treatment is based on assumptions of how similar conditions are managed when not relating to TBI. As the body of the literature expands and targeted treatments start to emerge for TBI, the function of pharmacological management will need to be further defined.

This article is part of a Special Issue entitled SI:Brain injury and recovery.

Abbreviations

• TBI, traumatic brain injury;
• CDC, Centers for Disease Control and Prevention;
• ED,emergency department;
• AHRQ, US Agency for Healthcare Research and Quality;
• NMDA, N-methyl-D-aspartate;
• DRS, disability rating scale;
• CSM, cerebral state monitoring;
• PTSD, post-traumatic stress disorder;
• GABA, gamma aminobutyric acid;
• CCI, controlled cortical impact;
• TCA, tricyclic antidepressant;
• MAS, Modified Ashworth Score;
• SCI, spinal cord injury;
• MS, multiple sclerosis;
• BoNT, Botulinum toxin;
• ITB,intrathecal baclofen

Source: Pharmacotherapy in rehabilitation of post-acute traumatic brain injury

Randomized Controlled Trial of Light Therapy for Fatigue Following Traumatic Brain Injury

…Conclusions. Blue light therapy appears to be effective in alleviating fatigue and daytime sleepiness following TBI and may offer a noninvasive, safe, and nonpharmacological alternative to current treatments…

μέσω Randomized Controlled Trial of Light Therapy for Fatigue Following Traumatic Brain Injury.