Posts Tagged TBI

[WEB SITE] Hot Topic Module: Changes in Memory After Traumatic Brain Injury

This Hot Topic Module consists of a suite of resources to help individuals with traumatic brain injury understand changes in memory after TBI and offers strategies that can help people who experience this function more effectively.


TBI and Memory Resources

VIDEOS: Changes in Memory After Traumatic Brain Injury
Our featured video and brief video clips explain changes in memory after traumatic brain injury (TBI). Jason Cowper and Tonya Howell share their stories of coming to terms with changes in their memory, and strategies they use to compensate for these changes. The video also includes the perspectives of TBI experts at the Texas TBI Model System of TIRR Memorial Hermann, who provide clinical insight on the changes in memory that some people experience after sustaining a TBI. View the featured video here. View additional video clips here.

FACTSHEET: Memory and Moderate to Severe Traumatic Brain Injury
This fact sheet explains memory problems that may affect people with moderate to severe traumatic brain injury (TBI). By understanding the new limits on their memory and ways to help overcome those limits, people with TBI can still get things done every day. View the factsheet here.

SLIDESHOW: Memory and Moderate to Severe Traumatic Brain Injury
Memory problems are very common in people with moderate to severe TBI. The information in this slideshow explains memory problems that may affect people with moderate to severe TBI. By understanding the new limits on their memory and ways to help overcome those limits, people with TBI can still get things done every day. View the slideshow here.

Related Reso


FACTSHEET: Depression After Traumatic Brain Injury
Fatigue is one of the most common problems people have after a traumatic brain injury (TBI). If you are experiencing fatigue, there are things you can do to decrease feelings of exhaustion, tiredness, weariness or lack of energy. The information in this factsheet describes causes of fatigue after TBI and ways to help alleviate these problems. View the factsheet here.

FACTSHEET: Emotional Problems After Traumatic Brain Injury
A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems. This factsheet discusses possible emotional problems and what can be done about depression. View the factsheet here.

SLIDESHOW: Emotional Problems After Traumatic Brain Injury
Emotional problems occur in people after a traumatic brain injury (TBI). A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems. The information in this slideshow describes the causes of emotional problems after a TBI. View the slideshow here.

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[Editorial] Improving and Predicting Outcomes of Traumatic Brain Injury: Neuroplasticity, Imaging Modalities, and Perspective Therapy – Neural Plasticity

Each year, a new traumatic brain injury (TBI) event occurs in
an estimated 10 million people worldwide, particularly in
young adults. Not only is TBI the leading cause of longterm
disability and mortality worldwide, but it is also
expected to become the third largest cause of global disease
burden by 2020 [1, 2]. TBI is a challenging disease process,
both to treat and to investigate. TBI survivors often experience
substantial and lifelong cognitive, physical, and behavioral
impairments that require long-term access to health
care and disability services.
Over the past three decades, imaging modalities, such as
positron emission tomography (PET),functionalMRI (fMRI),
diffusion tensor imaging (DTI), and transcranial magnetic
stimulation (TMS), have played a pivotal role in predicting
TBI outcome and advancing TBI treatment [3].
Burgeoning evidences for neuroplasticity have shed light
on the potential therapeutic protocols focusing on synaptic
proteins, new network connections, inflammatory reactions,
and the recruitment of immune cells [4]. Future therapies,
including gene therapies or a combination of different pharmacologic
therapies and rehabilitative protocols, which may
benefit victims by targeting multiple mechanisms of recovery,
are of utmost interest and currently under heavy investigation
by devoting neuroscientists.
The articles contained in this special issue include 4
reviews and 2 original research papers: a quantitative study
focusing on predictors of recovery from TBI and a cohort
study on substance related disorder after TBI.

(i) TBI survivors suffer various functional and cognitive
sequelae that may impose serious medical and social
problems. J. Ma et al. reviewed the complicated
pathological mechanisms of diffuse axonal injury
(DAI) in an attempt to facilitate more accurate diagnosis
and hence improve the survival and life quality
of DAI patients.

(ii) Not many studies have discussed the role of synapses
after TBI. Z. Wen et al. provided a comprehensive
review on the role and mechanisms of synapses in
TBI and the correlation between key synaptic proteins
and neuroplasticity. The article also provides
insights on the role of synapses in the treatment
and prognosis of TBI.

(iii) Molecular studies concerning the microglia-induced
inflammation by M1 phenotype and antiinflammation
by M2 phenotype are a new strategy
for treatment of TBI. In the paper titled “The

Polarization States of Microglia in TBI: A New
Paradigm for Pharmacological Intervention,” H.
Xu et al. examined research on the polarization
of microglia and their roles in the inflammation
response and secondary brain injury after TBI. It is
hoped that decreasing M1 phenotype and increasing
M2 phenotype may shed light on the pharmacotherapy
of TBI.

(iv) Studies to locate the clinical predictors of recovery
from prolonged disorders of consciousness (PDC)
can be arduous. In the original research presented
by H. Abe et al., 14 TBI patients were investigated
using diffusion tensor imaging (DTI) for longterm
follow-ups of 1-2 years. The results disclosed
correlation between initial severity of PDC and
difference in axial diffusivity (AD) and the degree
of recovery from PDC (RPDC). Microstructural
white matter changes in this study implicate their
possible relationship with the degree of RPDC.

(v) Efforts to correct behavioral, cognitive, mood, and
executive impairment of TBI patients are costly.
The article “Rehabilitation Treatment and Progress
of Traumatic Brain Injury Dysfunction” by B. Dang
et al. compiles the current rehabilitation treatment
plans and outcomes of TBI in adults.

(vi) Whether TBI induces substance-related disorder
(SRD) is currently debatable. C.-H. Wu et al. carried
out a cohort study of 19 thousand TBI adults
with no history of mental disorders prior to brain
injury in the original paper titled “Traumatic Brain
Injury and Substance Related Disorder: A 10-Year
Nationwide Cohort Study in Taiwan.” Results show
that the overall incidence of SRD was 3.62-fold
higher in the TBI group and 9.01-fold in the severe
TBI group. The severity of TBI seems to have
strong correlation in the subsequent risks of SRD.

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[WEB SITE] Brain Injury News – September 2017 – CNS

09/29/2017 Early predictors of outcome after mild traumatic brain injury
09/29/2017 Scientists say fluids study could aid traumatic brain injury research
09/28/2017 Risk of hospitalization with neurodegenerative disease after moderate-to-severe traumatic brain injury in the working-age population
09/28/2017 Girl soccer players are five times more likely to return to the game after a concussion than boys
09/27/2017 Neuropsychological predictors of outcome following traumatic brain injury in adults
09/27/2017 Many people thought to be in ‘vegetative’ conditions may still be conscious
09/26/2017 Accelerated cognitive aging following severe traumatic brain injury
09/26/2017 Study shows modified blood thinner reduces the impact of traumatic brain injury
09/25/2017 Expression of masculine identity in individuals with a traumatic brain injury
09/25/2017 Memory decline after head injury may be prevented by slowing brain cell growth
09/21/2017 Risk factors and outcomes associated with post-traumatic headache after mild traumatic brain injury
09/21/2017 Seaweed may help heal injured brain tissue
09/20/2017 Provider perceptions of the assessment and rehabilitation of sexual functioning after traumatic brain injury
09/20/2017 New treatment option discovered for brain injury patients suffering from aggression
09/19/2017 Risk factors for myocardial dysfunction after traumatic brain injury
09/19/2017 Concussion drug could reverse brain damage by ‘releasing’ damaged cells
09/18/2017 Who among patients with acquired brain injury returned to work after occupational rehabilitation?
09/15/2017 Home environment as a predictor of long-term executive functioning following early childhood traumatic brain injury
09/15/2017 Concussion in teenagers increases the risk of multiple sclerosis in later life
09/14/2017 ndividual- and population-level impacts of traumatic brain injury and maternal characteristics on subsequent offending behavior
09/14/2017 Concussions in women: Rates, symptoms and recovery are different than men
09/13/2017 The association of cognitive reserve in chronic-phase functional and neuropsychological outcomes following traumatic brain injury
09/13/2017 Science Says: How repeated head blows affect the brain
09/12/2017 Online family problem solving for pediatric traumatic brain injury
09/12/2017 Smartphones could someday assess brain injuries
09/11/2017 Resilience after traumatic brain injury
09/08/2017 Brain biomarkers and pre-injury cognition are associated with long-term cognitive outcome in children with traumatic brain injury
09/07/2017 Remediation of social communication impairments following traumatic brain injury using metacognitive strategy intervention
09/07/2017 Lab-grown brain balls are starting to look more lifelike
09/06/2017 Citicoline in severe traumatic brain injury: indications for improved outcome
09/06/2017 Researchers testing theory that you can diagnose a concussion through saliva
09/05/2017 Work productivity loss after mild traumatic brain injury
09/01/2017 Non-invasive vagal nerve stimulation effects on hyperarousal and autonomic state in patients with posttraumatic stress disorder and history of mild traumatic brain injury
09/01/2017 Brain Glue’ repairs traumatic brain injuries

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[ARTICLE] Traumatic Brain Injury Severity, Neuropathophysiology, and Clinical Outcome: Insights from Multimodal Neuroimaging – Full Text

Background: The relationship between the acute clinical presentation of patients with traumatic brain injury (TBI), long-term changes in brain structure prompted by injury and chronic functional outcome is insufficiently understood. In this preliminary study, we investigate how acute Glasgow coma score (GCS) and epileptic seizure occurrence after TBIs are statistically related to functional outcome (as quantified using the Glasgow Outcome Score) and to the extent of cortical thinning observed 6 months after the traumatic event.

Methods: Using multivariate linear regression, the extent to which the acute GCS and epileptic seizure occurrence (predictor variables) correlate with structural brain changes (relative cortical atrophy) was examined in a group of 33 TBI patients. The statistical significance of the correlation between relative cortical atrophy and the Glasgow Outcome Score was also investigated.

Results: A statistically significant correlative relationship between cortical thinning and the predictor variables (acute GCS and seizure occurrence) was identified in the study sample. Regions where the statistical model was found to have highest statistical reliability in predicting both gray matter atrophy and neurological outcome include the frontopolar, middle frontal, postcentral, paracentral, middle temporal, angular, and lingual gyri. In addition, relative atrophy and GOS were also found to be significantly correlated over large portions of the cortex.

Conclusion: This study contributes to our understanding of the relationship between clinical descriptors of acute TBI, the extent of injury-related chronic brain changes and neurological outcome. This is partly because the brain areas where cortical thinning was found to be correlated with GCS and with seizure occurrence are implicated in executive control, sensory function, motor acuity, memory, and language, all of which may be affected by TBI. Thus, our quantification suggests the existence of a statistical relationship between acute clinical presentation, on the one hand, and structural/functional brain features which are particularly susceptible to post-injury degradation, on the other hand.


Long-term clinical outcome after traumatic brain injury (TBI) is predicated upon a large variety of often poorly understood factors which substantially complicate the task of identifying the relationship between acute clinical variables and chronic functional deficits. Nevertheless, understanding how post-TBI cortical atrophy patterns reflect acute-stage patient presentation may help to identify cortical areas that are likely to undergo substantial atrophy, and implicitly to isolate aspects of cognitive, affective and neural function which are at highest risk for long-term degradation.

Attempts to relate TBI-related changes in brain structure to clinical variables often involve structural brain variables provided by neuroimaging methodologies, such as magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) (13). In previous studies, quantitative metrics provided by acute neuroimaging of TBI patients have been used to describe the relationship between acute injury profiles and chronic dysfunction (47). By contrast, hardly any non-neuroimaging clinical variables have been identified which can be used to elucidate the pattern of structural brain changes after TBI. Nevertheless, the ability to incorporate such non-neuroimaging clinical descriptors into outcome forecasting models is important because many such descriptors—including the Glasgow Coma Score (GCS)—are recorded routinely by clinicians and relied upon during the treatment decision-making process.

In this study, we illustrate how two important TBI severity indicators that are routinely assessed by clinicians in the acute care setting and without the use of neuroimaging can be used to relate patient presentation in the acute stage of TBI to the pattern and extent of post-TBI cortical atrophy as well as to neurological outcome. These two indicators—the GCS and the occurrence of epileptic seizures during the acute stage of TBI—can likely assist in predicting cortical atrophy patterns and in evaluating the risk for poor neurological outcome. This study additionally identifies cortical regions whose susceptibility to post-traumatic atrophy is correlated significantly and reliably—in a statistical sense—with functional outcome and with clinical descriptors of TBI severity. […]

Continue —>  Frontiers | Traumatic Brain Injury Severity, Neuropathophysiology, and Clinical Outcome: Insights from Multimodal Neuroimaging | Neurology

Figure 1. (A) Quantification of the linear model’s ability to predict cortical atrophy extent at 6 months after injury. For each gyrus and sulcus, the null hypothesis that there is no statistically significant correlation between the predictor variables and the response variable (cortical thinning, in millimeters) was tested. Values of the F2,30 statistic for each statistical test are encoded on the cortical surface, subject to the false discovery rate correction for multiple comparisons. Darker red hues indicate higher significance of the statistical test and, consequently, stronger ability to predict cortical thinning for the areas in question. Regions where the null hypothesis was not tested because less than 90% of cortical thickness data were available (see text) are drawn in black. Regions where the test statistic was lower than the threshold F statistic of the reliability analysis permutation test are drawn in white. (B) Statistical significance of the correlation between relative cortical atrophy and the GOS-E. Values of the t31 statistic for each statistical test are encoded on the cortical surface, as in panel (A). Note that all values of this statistic are negative, which confirms that greater regional atrophy is associated with lower GOS-E values (i.e., poorer functional outcome), as expected. The values of F and t statistics in (A) and (B), respectively, are associated with different statistical tests and different degrees of freedom and, therefore, they should not be compared to one another.

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[WEB SITE] Transcranial electrical stimulation shows promise for treating mild traumatic brain injury


Credit: copyright American Heart Association

Using a form of low-impulse electrical stimulation to the brain, documented by neuroimaging, researchers at the University of California San Diego School of Medicine, Veterans Affairs San Diego Healthcare System (VASDHS) and collaborators elsewhere, report significantly improved neural function in participants with mild traumatic brain injury (TBI).

Their findings are published online in the current issue of the journal Brain Injury.

TBI is a leading cause of sustained physical, cognitive, emotional and behavioral problems in both the civilian population (primarily due to , sports, falls and assaults) and among military personnel (blast injuries). In the majority of cases,  is deemed mild (75 percent of civilians, 89 percent of military), and typically resolves in days.

But in a significant percentage of cases, mild TBI and related post-concussive symptoms persist for months, even years, resulting in chronic, long-term cognitive and/or behavioral impairment.

Much about the pathology of mild TBI is not well understood, which the authors say has confounded efforts to develop optimal treatments. However, they note the use of passive neuro-feedback, which involves applying low-intensity pulses to the brain through transcranial  (LIP-tES), has shown promise.

In their pilot study, which involved six participants who had suffered mild TBI and experienced persistent post-concussion symptoms, the researchers used a version of LIP-tES called IASIS, combined with concurrent electroencephalography monitoring (EEG). The  effects of IASIS were assessed using magnetoencephalography (MEG) before and after treatment. MEG is a form of non-invasive functional imaging that directly measures brain neuronal electromagnetic activity, with high temporal resolution (1 ms) and high spatial accuracy (~3 mm at the cortex).

“Our previous publications have shown that MEG detection of abnormal brain slow-waves is one of the most sensitive biomarkers for mild  (concussions), with about 85 percent sensitivity in detecting concussions and, essentially, no false-positives in normal patients,” said senior author Roland Lee, MD, professor of radiology and director of Neuroradiology, MRI and MEG at UC San Diego School of Medicine and VASDHS. “This makes it an ideal technique to monitor the effects of concussion treatments such as LIP-tES.”

The researchers found that the brains of all six participants displayed abnormal slow-waves in initial, baseline MEG scans. Following treatment using IASIS, MEG scans indicated measurably reduced abnormal slow-waves. The participants also reported a significant reduction in post-concussion scores.

“For the first time, we’ve been able to document with neuroimaging the effects of LIP-tES treatment on brain functioning in mild TBI,” said first author Ming-Xiong Huang, PhD, professor in the Department of Radiology at UC San Diego School of Medicine and a research scientist at VASDHS. “It’s a small study, which certainly must be expanded, but it suggests new potential for effectively speeding the healing process in mild traumatic injuries.”

Source: Transcranial electrical stimulation shows promise for treating mild traumatic brain injury

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[WEB SITE] Virtual Reality, Real Medicine: Treating Brain Injuries With VR

The controlled environment of virtual reality is proving ideal for diagnosing and treating traumatic brain injuries. Learn why the Department of Defense is funding trials.

For some people, virtual reality is anything but a game. For some traumatic brain injury patients, it’s a means to living a normal life.

Meet Dr. Denise Krch, a research scientist and one of the leaders in virtual reality (VR) applications for sufferers of traumatic brain injuries (TBI). Krch has won grants from the National Institute on Disability, Independent Living, and Rehabilitation Research and from the Department of Defense (DOD) for her promising research, and works with the DOD to help impaired soldiers.

Krch doesn’t ask a patient to strap on an Oculus Rift or an HTC Vive. In fact, her VR doesn’t use headsets at all. That surround experience is called immersive VR. What Krch uses is non-immersive. Her VR is shown on a computer monitor and is more like a video game in which a player uses a joystick and mouse to manage real-world situations.

For TBI sufferers, distractions and the need to juggle multiple tasks can make the typical workplace impossible to navigate. They find their thoughts batted around by each new interruption, and are unable to focus on one task for long. It’s frustrating and frightening. Krch’s VR applications don’t transport patients to far-off worlds; they put patients in the middle of an office, one that grows more distracting as they progress.

Krch is based in East Hanover, N.J., at a division of the Kessler Foundation, a nonprofit that assists people with physical disabilities, and she is affiliated with Rutgers University’s New Jersey Medical School, but she owes her interest in VR to a guest from the West. Seven years back, Albert “Skip” Rizzo, the director for medical virtual reality at the University of Southern California’s Institute for Creative Technologies, visited the Kessler Foundation to share his research in VR as a treatment Krch was impressed with the role VR can play in rehabilitation and rebuilding cognitive functions that are difficult to improve.

She was so impressed, in fact, that she began working with Sebastian Koenig, then a post doctorate student and researcher in Rizzo’s lab, on a new trial.

Krch’s work deals with the cognitive area called executive function, which includes our ability to organize, plan, and shift attention from one task to another or keep two things in mind at once. Impairments in this area are difficult to measure in neuropsychological assessments. The first challenge Krch and Koenig tried to solve was measuring executive function performance. They wanted to use VR to determine which patients were having trouble multitasking or switching attention in real world situations.

From left to right: Sebastian Koenig, Ph.D., CEO of Katana Simulations; Albert “Skip” Rizzo, Ph.D., director of medical virtual reality, Institute for Creative Technologies; Denise Krch, Ph.D., research scientist in the Traumatic Brain Injury Laboratory at Kessler Foundation Research Center; Nancy Chiaravalloti, Ph.D., director of the Neuropsychology and Neuroscience Laboratory and Traumatic Brain Injury Laboratory at Kessler Foundation Research Center

To do that, they created software that put the test subjects in a virtual environment where they were challenged to perform tasks while distracted or where they were forced to shift focus. The researchers ran their tests with a healthy control population and with patients they suspected of having impairments. Some of these patients had TBI, while others had multiple sclerosis (MS).

The VR environment put subjects in an office where they were seated at a desk and charged to pay attention to different messages coming through their computer. Some messages were spam, which they had to learn to ignore. Other emails required a response. Many included real estate offers, and the subjects had to decide whether to accept offers or decline them.

Besides making financial decisions, subjects had to keep watch on an office projector. That projector wasn’t visible from where they were seated, but was in a nearby conference room. Told that the projector’s light was on the fritz, they needed to turn and check on it frequently while managing their other tasks.

“We found that indeed our patient populations were actually seemingly intact or normal on our traditional neuropsych measures, but they were performing in the very impaired range when we looked at them using VR,” Krch says.

To understand why this video-game-like experience is called VR, it’s necessary to understand “presence”—the feeling of how much believability an immersive situation offers. For a test to be effective, patients need to feel like they’re in a believable scenario. Krch and Koenig’s simulation proved to be extremely believable, stressing out TBI patients in no time with competing stimuli. While creating actual physical spaces could test the same functions, that isn’t practical, and bringing patients into stores or similar real-world locations can lead to safety issues. Using VR better helps researchers control the experience: They can precisely monitor stimuli and responses while generating clinical data.

“In a virtual environment, you have complete control over whether the environment was fairly sterile and limited in distraction. As they were able to build to tolerating more distraction, you could add. So really that’s the biggest advantage of having a virtual environment,” Krch explains.

That trial successfully tested for a variety of impairments in attention and executive function. It showed impairments in the ability “to remember to remember,” called prospective memory, in turning to check the projector. Responding to emails tested selective attention where the subject chooses to focus on one thing and not another. Determining whether or not to accept the real estate offers tested problem solving. TBI and MS patients who didn’t show problems on standard neuropsych tests showed problems across the board when using VR.

Testing showed subjects had the biggest problem with interruptions. The biggest stressor in the experience was a phone ringing in the background. Hearing an unanswered phone ring over and over really derailed people’s thoughts. Krch and Koenig used their data to come up with rehabilitation programs that also use VR, and then to write a grant proposal to fund new software that can improve problems with divided attention (multitasking) and set shifting (switching between tasks). Funding by the National Institute of Disability, Independent Living, and Rehabilitation Research led to 3 years of development work with clinicians and TBI patients, and the recent start of randomized clinical trials. Testing involves eight treatments conducted over 4 weeks. The 15 subjects are being tested before and after treatments to monitor progress. Krch began the trial the week before this interview, so she didn’t yet have data.

In this testing, Krch and Koenig’s VR office software has gotten an upgrade. Now the subject works at a corporation that makes a toy animal called the Wonderkin. While there’s plenty of usual office chores, such as sitting at a desk and making decisions about emails coming in, the toy animals add a little fun. One treatment module is set in a laboratory where subjects have to check whether or not toys are broken. Toy horses, goats, and pigs jump around, while subjects make sure they aren’t breaking. The idea in this and other modules is to create a game-like treatment where patients have fun while improving attention skills. As subjects improve, the difficulty rises.

Since this is a clinical treatment and not an evaluation tool, a clinician works with each subject to keep him or her on course. If the subject starts to feel overwhelmed by distractions, the clinician starts the patient on something simpler and helps the person build up.

Krch has a second grant-funded trial going, also continuing work started in Skip Rizzo’s USC–ICT lab. Funded through multiple Department of Defense studies, this treatment seeks to improve balance.

“The DOD has tremendous interest in finding treatments that help rehabilitate individuals with traumatic brain injuries,” Krch says. “As a matter of fact, now having been DOD funded and involved within the DOD system and learning about the DOD system, they actually fund a wide range of things from cerebral palsy research to cancer research to things that seemingly you wouldn’t think the military would care about. But the military serves not just the people who are serving directly, but their families.”

With many soldiers coming back from combat with concussions and TBIs, the DOD has funded a good deal of research in the area, especially studies that use tech simulations. Rizzo is also developing military-funded treatments for veterans, using VR to treat post-traumatic stress disorder.

Sebastian Koenig, Ph.D., and Denise Krch, Ph.D., with the VR simulation they use to help patients with traumatic brain injury overcome distractions typical in workplace environments

Krch’s randomized clinical trials on balance use VR software displayed on a large wall-mounted monitor. An infrared beam detects the subject’s body and the screen shows an avatar in a virtual environment. Testing with active duty personnel is done at Fort Belvoir Community Hospital in Fort Belvoir, Va. Krch’s VR balance treatments don’t currently use headsets, but that’s changing. Patients are more prone to fall when wearing a headset, and the immersive experience can lead to “simulator sickness,” which is becoming less of a problem as VR hardware improves. Krch’s team is adapting a VR program called the Fruit Toss to headsets. In it, fruits fly at the test subject, who has to either catch or kick them. Krch hopes to have it completed by the end of the year. Her team is currently collecting data and feedback on immersive VR tests, which they’ll use as pilot data for an immersive technology grant proposal.

“Our lives are full of distractions. You’ve got a kid in one hand and you’re closing the door. You’re helping a child with homework and you’re cooking, or you are on the phone with your health insurance company and you’re balancing your checkbook. The demands of our lives constantly require us to switch our attention a lot and to do more than one thing at a time,” Krch says. And that’s true in the office, as well: “Most job scenarios nowadays expect you to be able to multitask and to do it in the presence of many, many distractors.” With help from treatments like those Krch is creating, TBI patients are able to return to the workforce sooner and MS patients are able to stay at their jobs longer. That means a better social environment and better quality of life.

The virtual reality environment might still feel like a game, but the results of Krch’s work are a better payoff than any high score.

[This article appears in the September 2017 issue of Streaming Media Magazine as “Virtual Reality, Real Medical Carea.”]

Source: Virtual Reality, Real Medicine: Treating Brain Injuries With VR – Streaming Media Magazine

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[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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