Posts Tagged TBI

[Abstract] Provider perceptions of the assessment and rehabilitation of sexual functioning after traumatic brain injury – CNS

OBJECTIVE: To explore how health care professionals who work with individuals with TBI address issues related to the assessment and treatment of sexuality after TBI.
METHODS: A survey composed of 53 questions was developed to evaluate professional training, assessment of sexuality in individuals with TBI and attitudes towards sexuality. The sample consisted of 324 self-identified TBI health care professionals.
RESULTS: Ninety seven per cent of participants believed that sexuality should be discussed during rehabilitation; however, 36% reported talking about it. Seventy nine per cent reported that their patients have asked about sexuality after TBI, with 60% feeling calm and competent addressing the topic. The main reason for not discussing the topic was that patients do not ask for information (42%). Assessment (87%) and treatment of sexuality (82%) in individuals with TBI are considered a part of their professional responsibility.
CONCLUSION: Despite recognition of the importance of addressing the topic and the belief of it being their professional responsibility, many professionals reported lack of training. Working to increase comfort with the topic and providing comprehensive education on treating sexuality may be beneficial.

Source: Traumatic Brain Injury Resource Guide – Research Reports – Provider perceptions of the assessment and rehabilitation of sexual functioning after traumatic brain injury


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[WEB SITE] Cognitive fatigue after TBI linked with caudate activation

Individuals with neurological damage often report difficulties with cognitive fatigue, a subjective lack of mental energy that is perceived to interfere with daily activities. Because of poor correlation between self-reports of cognitive fatigue and tests of cognitive performance, scientists are looking at more objective measures, such as correlations with neuroimaging findings. In the Kessler study, brain activation patterns were compared in 22 individuals with moderate to severe TBI and 20 healthy controls. Both groups performed tasks of working memory during functional MRI imaging of the brain; the TBI group reported more fatigue, although performance was comparable between the groups. The results showed that the experience of self-reported fatigue is associated with activation changes in the caudate nucleus of the basal ganglia.

“These results are consistent with findings in our related research in the multiple sclerosis (MS) population,” said Dr. Wylie, the lead author, “which suggests that the TBI and MS populations share a mechanism for cognitive fatigue.” This has important implications for the development of effective treatments. “This study points to the caudate nucleus as a likely target for clinical interventions to alleviate fatigue,” explained Dr. Wylie, who is associate director of Neuroscience Research and the Rocco Ortenzio Neuroimaging Center at Kessler Foundation.

Story Source:

Materials provided by Kessler Foundation. Note: Content may be edited for style and length.

Journal Reference:

  1. G. R. Wylie, E. Dobryakova, J. DeLuca, N. Chiaravalloti, K. Essad, H. Genova. Cognitive fatigue in individuals with traumatic brain injury is associated with caudate activation. Scientific Reports, 2017; 7 (1) DOI: 10.1038/s41598-017-08846-6

Source: Cognitive fatigue after TBI linked with activation of caudate: Findings underscore the role of the caudate nucleus in the mechanism of cognitive fatigue in traumatic brain injury — ScienceDaily

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[WEB SITE] TBI Basics – BrainLine

A TBI can happen to anyone, whether it happens while playing sports, at work, or just slipping on an icy sidewalk. Injuries can range from “mild” to “severe”, with a majority of cases being concussions or mild TBI. The good news is that most cases are treatable and there are several ways to help prevent injury.

What You’ll Find Here

You Are Not Alone

You Are Not Alone

See how others are navigating their post-TBI lives. Check out personal stories and “life after TBI” blogs, or join the conversation with our Facebook community.

Source: TBI Basics | BrainLine

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[Dissertation] Perceived Self-Efficacy in Individuals with Moderate-to-Severe Brain Injury: The Effects of Rehabilitation Outcomes and Depression – Full Text PDF


Brain injury represents a major public health issue in the United States, accounting for a largely underestimated figure of 2.5 million cases in 2010. The pervasive effects of this chronic medical condition contribute to a growing economic burden, as the physical, cognitive, behavioral, and emotional sequelae of brain injury demand long-term care for those with moderate-to-severe brain injuries. The Centers for Disease Control and Prevention recently proposed new recommendations for improvements in monitoring the incidence of and research on brain injury. The goals of this public health initiative are to better inform health service delivery and ultimately improve quality of life for those affected, as well as their loved ones.
In addition to improved quality of life, community reintegration is a primary goal
of brain injury rehabilitation. Engagement in rehabilitation is largely dependent upon an individual’s level of impairment, as well as other personal factors. For example, research examining the relationship between targeted interventions and community participation has established support for the protective effects of self-efficacy, or personal belief in one’s abilities to achieve a desired goal. Additional research on the importance of selfefficacy to psychological health has provided further support for the protective effects of this construct against depression and anxiety. Therefore, further research into the relationship between rehabilitation outcomes, psychological health, and self-efficacy is necessary to inform recommendations for improving health service delivery and quality of life for this vulnerable population.

The aim of the present study is to examine factors that may be related to self
efficacy in persons with moderate-to-severe brain injury who receive treatment at along term post acute brain injury program. The implications of this research include baseline assessment of self-efficacy in this sample that could potentially inform future staff training and overall clinical practice geared towards cultivating self-efficacy in persons with brain injury. The primary limitations of this study are its small sample size and constrained external validity. Despite these limitations, more research is necessary to understand the role of psychological protective factors in brain injury rehabilitation and to inform strategies for improved health service delivery and increased quality of life.

Full Text PDF 


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[WEB SITE] Stress and Stress Management Post-TBI – BrainLine

Stress and Stress Management Post-TBI


Why does stress bring back my TBI symptoms with a vengeance? It feels like a knife reopening a wound. What goes wrong in the brain after injury that makes this happen?


Stress occurs when there is a gap between the current task demands and the resources you have to meet those demands. Your brain interprets this as a threat. Acute stress — as in immediate physical danger — produces a physical reaction (the fight-or-flight response) that includes increased pupil dilation, perspiration, increased heart rate and blood pressure, rapid breathing, muscle tension, and increased mental alertness. However, less immediately threatening or prolonged stressors, such as ongoing money problems, too many things to get done in one day, even something like unexpected company, will produce these reactions. They may occur to a lessor degree, but ongoing stress reactions, even mild ones, will result in your body preparing for a long-term protective response.

Fatigue, concentration lapses, irritability, and lethargy result as the stress continues without relief. You probably recognize these as some of the TBI symptoms you feel coming back with a vengeance. Having experienced a TBI makes you both more susceptible to these symptoms, and these symptoms make it more difficult for you to effectively use whatever coping or compensatory strategies you may have developed to manage your TBI symptoms.

Learning to manage stress is important for all of us, and of particular importance to the recovery process after TBI. Techniques such as relaxation, time management, goal-setting, organization, cognitive-behavioral techniques, and lifestyle modifications can all be helpful in managing stress. It is recommended that you get some help and support in figuring out which of these techniques will be most useful for you from a mental health provider, a case manager, a life coach, a support group, or even a good friend if the stress levels are not overwhelming or seriously affecting your life. There are plenty of resources available for stress management, and a lot of information online, but sifting through it and tailoring it for your particular needs may be challenging without some support.

For more information on stress and stress management, click here.

Source: Stress and Stress Management Post-TBI | BrainLine

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[WEB SITE] Managing fatigue after a brain injury – Synapse

Fatigue is a common and very disabling symptom experienced by people with a brain injury.

It may be a continual sense of mental fatigue or it can happen when a person is trying to do too much and the brain is overloaded, often resulting in mind-numbing fatigue that can last for several days.

Brain disorders such as traumatic brain injury can be likened to a highway when one of three lanes is closed down. If traffic is light, there will be no difference but once the traffic reaches a critical point, the cars barely move and it can take ages for the traffic jam to clear.

It is important to avoid fatigue as much as possible, as any other problems are worsened as well, such as:

  • Vision problems
  • Slurred speech
  • Difficulty finding words
  • Poor concentration
  • Cramps or weak muscles
  • Poor coordination or balance.

Fatigue can occur for no apparent reason or after physical activity, but is quite likely to occur from too much mental activity. Examples include planning the week’s errands, organizing a work schedule or simply reading.

Fatigue can be managed with good planning and rest periods, but carers and the family member must realize fatigue is a very real problem.

Symptoms of fatigue

The following symptoms may all suggest fatigue:

  • Withdrawal, short answers, dull tone of voice
  • Loss of appetite
  • Shortness of breath
  • Slower movement and speech
  • Irritability, anxiety, crying episodes
  • Increased forgetfulness
  • Lack of motivation and interest.

What are the triggers of fatigue?

Work out what triggers it and what factors make the symptoms worse, such as long conversations, noisy shopping centres, movies with complicated plots, or talking with two or more people at once.

In some cases, fatigue could be a side-effect of certain medications, in which case you should discuss options with your doctor.

Be aware of the first signs of fatigue and immediately stop and rest – overloading your brain can easily result in several days of extreme tiredness. Make a note of how long you can do certain activities before fatigue starts e.g. if fatigue starts after 30 minutes of reading, only read for 20 minutes in future.

Managing fatigue

Contingency plans: Fatigue may occur at the least convenient times – on public transport or during a meeting. You need to negotiate ways of coping when this happens. You can use specific strategies or call in extra support. Work out contingency plans with your family member. Your rehab team, occupational therapist or physiotherapist can help with suggestions.

Assess best hours: Some people function best in the mornings, so complete demanding tasks then. Others function better in the afternoon or the evening. Organize your routine accordingly. Don’t drive when you are tired.

Assess your environment: Provide an uncluttered environment that is easy to move around and work in. Think about how and where things are stored; bench heights, entrances, types of furnishing and lighting. For example, some people may find fluorescent lighting or dim lighting more tiring.

Schedule rest periods: Make a daily or weekly schedule, and include regular rest periods. “Rest” means do nothing at all. If you have a nap, don’t oversleep in case this affects your normal sleep cycle.

Use aids: Use mechanical aids to conserve energy for when it really counts. One man spared his legs extra effort by using his wheelchair to get from his house to the car, then from the car to the church, before walking his daughter, the bride, down the aisle.

Break it down: Break down activities into a series of smaller tasks. This provides opportunities to rest while allowing the person to complete the task. Encourage sensible shortcuts.

Set priorities: Focus on things that must be done and let the others go.

Medication highs and lows: Be aware of changes throughout the day that relate to medication. Is the person better or worse immediately after their tablets? Plan their activities around these times.

Weather: Hot weather can also increase fatigue. Plan around this.

Seek support: Ask for advice. In particular, an occupational therapist can visit your home and advise on an energy-conserving plan. For more information, talk to your doctor or condition-specific support organization.

Healthy lifestyle

AS with virtually every aspect of a traumatic brain injury and similar brain disorders, fatigue will be less of a problem if you focus on a healthy lifestyle:

  • Sleep well
  • Get regular exercise
  • Avoid alcohol or limit your intake
  • Eat a healthy diet and watch your weight
  • Learn stress management techniques
  • Maintain contact with friends and family.

Source: Managing fatigue after a brain injury – Synapse – reconnecting lives

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[CORDIS Project] Motor Recovery with Paired Associative Stimulation (RecoveriX) – European Commission

Motor Recovery with Paired Associative Stimulation (RecoveriX)


Source: European Commission : CORDIS : Projects and Results : Motor Recovery with Paired Associative Stimulation (RecoveriX)

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[BLOG POST] 7 Things You Should Never Say To Someone With TBI or PTS

If you have a friend or loved one who is suffering from a psychological health condition like TBI, it can be hard at times to express your compassion through general words. It’s important to be sensitive when speaking to them about their struggles, and it is crucial for them to have your support during this challenging time.

While there is no doubt that you mean well, just a few simple words that don’t mean much to you can actually be painful for them to hear.

“You don’t look sick.”
Not showing physical symptoms of being ill doesn’t mean that illness is not there. While there can sometimes be slight, but noticeable changes in appearance, many of the changes are mental, such as feeling emotionally numb, experiencing panic attacks, and having suicidal thoughts.

“You’re lucky! It could’ve been worse.”
There is nothing that is lucky about living with a psychological health condition. Every day can come with a new set of challenges.

“Are you sure it’s not just all in your head?”
As previously stated, it can be hard for someone to understand what a person suffering from TBI is going through because those symptoms and changes aren’t physical. This battle is internal and is a very real illness. Saying this can just make them feel as if their psychological health conditions aren’t real and could prevent them from seeking the professional help they need. It can also lead to giving them unnecessary stress and anxiety. Read more about the stigma of mental illness.

“Maybe you should just get out more.”
Certain social situations can be overwhelming for those who suffer from psychological health conditions. Loud noises and crowds can often be a stress-inducing trigger, so avoiding them can be better for their health.

“Just look on the bright side!”
While positivity and optimism play a key role in getting better, “looking on the bright side” won’t treat psychological health conditions alone.

“What if you just stop thinking about it?”
When someone experiences a traumatic event, it’s hard to erase that impactful moment from their life. Oftentimes, that moment will replay itself in that person’s head over and over again. Experiencing these flashbacks can lead to destructive behavior to try and block out the memory.

“Have you tried _________?”
There are many ways to help treat psychological health conditions, but leave it to the experts to find what works best for the patient. (Unless you’re asking them if they’ve tried to seek professional treatment. Then by all means, please encourage that!)

The greatest things that you can say to someone who is fighting TBI are genuine words of support. Let them know you’re there for them and that you believe that what they’re going through is a real illness. They’ll appreciate that more than anything else.

Source: Intrepid Fallen Heroes Fund – 7 Things You Should Never Say To Someone With TBI or PTS


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[ARTICLE] Functional Magnetic Resonance Imaging of Cognitive Control following Traumatic Brain Injury

Novel and non-routine tasks often require information processing and behavior to adapt from moment to moment depending on task requirements and current performance. This ability to adapt is an executive function that is referred to as cognitive control. Patients with moderate-to-severe traumatic brain injury (TBI) have been reported to exhibit impairments in cognitive control and functional magnetic resonance imaging (fMRI) has provided evidence for TBI-related alterations in brain activation using various fMRI cognitive control paradigms. There is some support for greater and more extensive cognitive control-related brain activation in patients with moderate-to-severe TBI, relative to comparison subjects without TBI. In addition, some studies have reported a correlation between these activation increases and measures of injury severity. Explanations that have been proposed for increased activation within structures that are thought to be directly involved in cognitive control, as well as the extension of this over-activation into other brain structures, have included compensatory mechanisms, increased demand upon normal processes required to maintain adequate performance, less efficient utilization of neural resources, and greater vulnerability to cognitive fatigue. Recent findings are also consistent with the possibility that activation increases within some structures, such as the posterior cingulate gyrus, may reflect a failure to deactivate components of the default mode network (DMN) and that some cognitive control impairment may result from ineffective coordination between the DMN and components of the salience network. Functional neuroimaging studies examining cognitive control-related activation following mild TBI (mTBI) have yielded more variable results, with reports of increases, decreases, and no significant change. These discrepancies may reflect differences among the various mTBI samples under study, recovery of function in some patients, different task characteristics, and the presence of comorbid conditions such as depression and posttraumatic stress disorder that also alter brain activation. There may be mTBI populations with activation changes that overlap with those found following more severe injuries, including symptomatic mTBI patients and those with acute injuries, but future research to address such dysfunction will require well-defined samples with adequate controls for injury characteristics, comorbid disorders, and severity of post-concussive symptoms.

Traumatic brain injury (TBI) is a neurological insult of major public health significance with over 1.7 million new injuries each year among Americans under the age of 35 (1). Numerous studies, most of which have been conducted with moderate-to-severe TBI due to blunt head trauma, have reported findings consistent with a mixed and highly heterogeneous neuropathology that may include multifocal or diffuse axonal injury, as well contusions and other focal lesions (2). Additional injury may occur as a result of edema, herniation, hemorrhage, ischemia, inflammation, and excitotoxic processes (2, 3). Structures and connections of the frontal and limbic regions have been said to be especially vulnerable to these various pathological processes (3, 4). Executive functions are highly dependent on the integrity of this neural substrate, and it is not surprising that such functions, including cognitive control, are often impaired following TBI (57).

Cognitive control allows for flexibility in human thought and behavior and may be defined as the ability to pursue task-related goals in the presence of conditions that include conflicting information or interference, prepotent response alternatives, or the need to interrupt or switch an ongoing activity (810). A common factor in all of these situations is the top-down direction, or biasing, of cognition and this is necessary for information processing and behavior to adapt from moment to moment depending on task requirements and performance (8, 11, 12). Cognitive control relies upon the active maintenance of neural activity associated with the internal representation of goals and task-related rules or contingencies (1113). However, it is a complex construct that likely includes multiple component processes, some of these processes overlap with those of other executive functions (e.g., working memory), and it contributes to performance on various high level cognitive tasks, including those representing domains such as attention, memory, and language (810, 14).

Although prefrontally guided top-down direction is critical for cognitive control and other executive functions, the prefrontal cortex (PFC) is only one of several structures that contribute to cognitive control (15). Another important structure is the anterior cingulate cortex, which is thought to monitor performance and internal bodily states associated with task-related reward conditions, to determine whether task performance is adequate, and to signal to the dorsolateral PFC when mental effort or top-down direction needs to be increased (11, 1517). Some anterior cingulate functions, including the detection of states associated with reward and expected outcomes, likely depend on distant connections with structures such as the insula (17). These various structures may be vulnerable to disconnection associated with diffuse axonal injury and other TBI-related neuropathology (1820).

Functional magnetic resonance imaging (fMRI) provides an indirect measure of neural activity and has the potential to reveal changes in brain function associated with neuropathology, including alterations following TBI (21, 22). One powerful application of this method is the use of fMRI paradigms to examine brain activation during cognitive tasks (22), including those which place a demand upon executive functions such as cognitive control. This type of research has the potential to reveal relationships between specific cognitive impairments and dysfunction within the underlying neural substrate, to provide a neuroimaging marker that may contribute to differential diagnosis, and to lead to the development of methods to track changes in brain activity associated with recovery and treatment (23). Cognitive control is a high level function that is critical for the completion of many complex and non-routine tasks (8, 11). Despite the importance of this topic and the incredible potential offered by fMRI research, only a few studies have examined changes in cognitive control-related activation following TBI, and these have often suffered from various methodological limitations. The purpose of this article is to provide an overview of that existing research, to discuss findings that contribute to our understanding of how cognitive control may be impaired following TBI, and to provide some suggestions to improve future research and increase its relevance.

Although fMRI research has also investigated working memory and other executive functions following TBI (24, 25), the current review will focus on cognitive control by examining fMRI studies that have specifically addressed the top-down direction of cognition and related cognitive control processes (e.g., performance monitoring). This research has employed fMRI paradigms adapted from common clinical measures of cognitive control, such as the Stoop Test (26), as well as experimental procedures developed specifically for the purpose of acquiring fMRI data [e.g., Ref. (27)]. Studies using paradigms that assess other functions, such as working memory or attention, are also included within this review if they had incorporated procedures to investigate top-down control [e.g., Ref. (28)]. Some had utilized a block design approach [e.g., Ref. (29)], whereas others had employed event-related fMRI [e.g., Ref. (30)]. A major feature of block design fMRI paradigms is that this method combines images acquired across an entire block of trials, which then prevents the separation of images acquired within a block to examine activation relative to different types of stimuli or responses (31). Event-related designs have the advantage of allowing the examination of images at the trial level, including the ability to isolate correct or incorrect responses, but these designs typically have less statistical power (31). It is also possible to capitalize upon some of the advantages of both approaches by employing a mixed design (32). […]

Continue —> Frontiers | Functional Magnetic Resonance Imaging of Cognitive Control following Traumatic Brain Injury | Neurology

Figure 3. Integrity of the white matter tract connecting the right anterior insula with the pre-supplementary motor area and the dorsal anterior cingulate cortex (rAI-preSMA/dACC) predicts default mode network deactivation during the stop-signal task. (A) Coronal view of the rAI-preSMA/dACC tract (blue) overlaid on the activation map for the contrast comparing correct stop trials with correct go trials (StC > Go) in traumatic brain injury (TBI) patients (orange). (B) Fractional anistropy (FA) of the rAI-preSMA/dACC tracts in TBI patients plotted against the percent signal change within a precuneus/posterior cingulate gyrus (Precu/PCC) region of interest on correct stop trials relative to go trials. FA measures are normalized and are corrected for age and whole-brain FA. (C) Sagittal view of brain regions with a negative correlation between activation for the StC > Go contrast and FA within the rAI-preSMA/dACC tract. Activation is superimposed on the Montreal Neurological Institute 152 T1 template (R = right side of image) [reused with permission from Ref. (18)].

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[BLOG POST] Alcohol, Seizures and Brain Injury  

A drunk driving accident.  A fight at a bar after a night of drinking.  Many brain injury survivors received their brain injuries while under the influence of alcohol.  In fact, studies have shown that between 35% and 81% of people who received a traumatic brain injury had been drinking at the time of their injury.  Doctors and therapists routinely recommend that survivors abstain from alcohol after a brain injury but some survivors ignore this advice.  But drinking after a brain injury has a new and more dangerous risk than before, namely post-injury seizures.

In general, brain injury survivors are more prone to developing a seizure disorder than are people without brain injuries.  Depending on the severity and location of a traumatic brain injury, research shows that post-traumatic brain injury seizure rates are between 2-50%.  Similarly, post-stroke seizure rates are between 5-20%.  Both of these are significantly higher than the seizure rate in the general population.

Unfortunately, alcohol can raise both the likelihood and frequency of post-injury seizures.  Alcohol lowers the threshold for seizures to occur, making a seizure more likely to happen.  For those already taking anti-seizure medication, alcohol can interfere with the performance of the medication, causing the medication to be ineffective and allowing more seizures to occur.  As a seizure can be a potentially life-threatening medical issue, anything that raises the likelihood of seizures should be avoided.

Overall, it is smart for many reasons to avoid consuming alcohol after an injury.  But the risk of seizures is an important reason which should not be ignored.

Learn about brain injury treatment services at the Transitional Learning Center! Visit us at:

Source: Alcohol, Seizures and Brain Injury | The Transitional Learning Center’s Blog

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