Posts Tagged TBI

[Abstract] Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology

Highlights

  • Virtual reality technology improves cognitive function post-traumatic brain injury.
  • Optimal treatment protocol is; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week.
  • There was weak evidence for positive effect of virtual reality on attention.

Abstract

Background

Traumatic brain injury (TBI) can causes numerous cognitive impairments usually in the aspects of problem-solving, executive function, memory, and attention. Several studies has suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of brain injury. Virtual reality (VR) technology potential as a useful tool for the assessment and rehabilitation of cognitive processes.

Objectives

The aims of present systematic review are to examine effects of VR training intervention on cognitive function, and to identify effective VR treatment protocol in patients with TBI.

Methods

PubMed, Scopus, PEDro, REHABDATA, EMBASE, web of science, and MEDLINE were searched for studies investigated effect of VR on cognitive functions post TBI. The methodological quality were evaluated using PEDro scale. The results of selected studies were summarized.

Results

Nine studies were included in present study. Four were randomized clinical trials, case studies (n = 3), prospective study (n = 1), and pilot study (n = 1). The scores on the PEDro ranged from 0 to 7 with a mean score of 3. The results showed improvement in various cognitive function aspects such as; memory, executive function, and attention in patients with TBI after VR training.

Conclusion

Using different VR tools with following treatment protocol; 10–12 sessions, 20–40 min in duration with 2–4 sessions per week may improves cognitive function in patients with TBI. There was weak evidence for effects of VR training on attention post TBI.

via Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology – Journal of Clinical Neuroscience

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[REVIEW ARTICLE] Blood Biomarkers for Traumatic Brain Injury: A Quantitative Assessment of Diagnostic and Prognostic Accuracy – Full Text

Blood biomarkers have been explored for their potential to provide objective measures in the assessment of traumatic brain injury (TBI). However, it is not clear which biomarkers are best for diagnosis and prognosis in different severities of TBI. Here, we compare existing studies on the discriminative abilities of serum biomarkers for four commonly studied clinical situations: detecting concussion, predicting intracranial damage after mild TBI (mTBI), predicting delayed recovery after mTBI, and predicting adverse outcome after severe TBI (sTBI). We conducted a literature search of publications on biomarkers in TBI published up until July 2018. Operating characteristics were pooled for each biomarker for comparison. For detecting concussion, 4 biomarker panels and creatine kinase B type had excellent discriminative ability. For detecting intracranial injury and the need for a head CT scan after mTBI, 2 biomarker panels, and hyperphosphorylated tau had excellent operating characteristics. For predicting delayed recovery after mTBI, top candidates included calpain-derived αII-spectrin N-terminal fragment, tau A, neurofilament light, and ghrelin. For predicting adverse outcome following sTBI, no biomarker had excellent performance, but several had good performance, including markers of coagulation and inflammation, structural proteins in the brain, and proteins involved in homeostasis. The highest-performing biomarkers in each of these categories may provide insight into the pathophysiologies underlying mild and severe TBI. With further study, these biomarkers have the potential to be used alongside clinical and radiological data to improve TBI diagnostics, prognostics, and evidence-based medical management.

Introduction

Traumatic brain injury (TBI) is a common cause of disability and mortality in the US (1) and worldwide (2). Pathological responses to TBI in the CNS include structural and metabolic changes, as well as excitotoxicity, neuroinflammation, and cell death (34). Fluid biomarkers that may track these injury and inflammatory processes have been explored for their potential to provide objective measures in TBI assessment. However, at present there are limited clinical guidelines available regarding the use of biomarkers in both the diagnosis of TBI and outcome prediction following TBI. To inform future guideline formulation, it is critical to distinguish between different clinical situations for biomarker use in TBI, such as detection of concussion, prediction of positive and negative head computed tomography (CT) findings, and prediction of outcome for different TBI severities. This allows for comparisons to determine which biomarkers may be used most appropriately to characterize different aspects of TBI.

The identification of TBI severity has become a contentious issue. Currently, inclusion in TBI clinical trials is primarily based on the Glasgow Coma Scale (GCS), which stratifies patients into categories of mild, moderate, and severe TBI. The GCS assesses consciousness and provides prognostic information, but it does not inform the underlying pathologies that may be targeted for therapy (56). Furthermore, brain damage and persistent neurological symptoms can occur across the spectrum of TBI severity, limiting the use of GCS-determined injury severity to inform clinical management. Biomarkers in TBI have the potential to provide objective and quantitative information regarding the pathophysiologic mechanisms underlying observed neurological deficits. Such information may be more appropriate for guiding management than initial assessments of severity alone. Since the existing literature primarily focuses on applications of biomarkers in either suspected concussion, mild TBI (mTBI), or severe TBI (sTBI), we will discuss biomarker usage in these contexts.

Concussion is a clinical syndrome involving alteration in mental function induced by head rotational acceleration. This may be due to direct impact or unrestrained rapid head movements, such as in automotive crashes. Although there are over 30 official definitions of concussion, none include the underlying pathology. Missing from the literature have been objective measures to not only identify the underlying pathology associated with the given clinical symptoms, but also to indicate prognosis in long-term survival. Indeed, current practices in forming an opinion of concussion involve symptom reports, neurocognitive testing, and balance testing, all of which have elements of subjectivity and questionable reliability (7). While such information generally reflects functional status, it does not identify any underlying processes that may have prognostic or therapeutic consequences. Furthermore, because patients with concussion typically present with negative head CT findings, there is a potential role for blood-based biomarkers to provide objective information regarding the presence of concussion, based on an underlying pathology. This information could inform management decisions regarding resumption of activities for both athletes and non-athletes alike.

Blood-based biomarkers have utility far beyond a simple detection of concussion by elucidating specific aspects of the injury that could drive individual patient management. For example, biomarkers may aid in determining whether a mTBI patient presenting to the emergency department requires a CT scan to identify intracranial pathology. The clinical outcome for a missed epidural hematoma in which the patient is either discharged or admitted for routine observation is catastrophic; 25% are left severely impaired or dead (8). The Canadian CT Head Rule (9) and related clinical decision instruments achieve high sensitivities in predicting the need for CT scans in mild TBI cases. However, they do this at specificities of only 30–50% (10). Adding a blood biomarker to clinical evaluation may be useful to improve specificity without sacrificing sensitivity, as recently suggested (11). In addition, given concern about radiation exposure from head CT scans in concussion cases, particularly in pediatric populations, identification of patients who would be best assessed with neuroimaging is crucial. Thus, the use of both sensitive and specific biomarkers may serve as cost-effective tools to aid in acute assessment, especially in the absence of risk factors for intracranial injury (12). S-100B, an astroglial protein, has been the most extensively studied biomarker for TBI thus far and has been incorporated into some clinical guidelines for CT scans (1314). However, S-100B is not CNS-specific (1516) and has shown inconsistent predictive capacity in the outcome of mild TBI (1718). Given that several other promising biomarkers have also been investigated in this context, it is important to evaluate and compare the discriminative abilities of S-100B with other candidate blood-based biomarkers for future use.

Blood biomarkers also have the potential to help predict unfavorable outcomes across the spectrum of TBI severity. Outcome predication is difficult; in mTBI, existing prognostic models performed poorly in an external validation study (19). Identifying biomarkers that best predict delayed recovery or persistent neurological symptoms following mTBI would help with the direction of resources toward patients who may benefit most from additional rehabilitation or prolonged observation. In sTBI, poorer outcome has often been associated with a low GCS score (20). However, factors such as intoxication or endotracheal intubation may make it difficult to assess GCS reliably in the acute setting (2122). The addition of laboratory parameters to head CT and admission characteristics have improved prognostic models (23). Thus, prognostic biomarkers in sTBI could help determine whether patients are likely to benefit from intensive treatment. Several candidate biomarkers that correlate with various pathologies of mild and severe TBI have been studied (24), but their relative prognostic abilities remain unclear.

Existing reviews on biomarkers in TBI have provided valuable insight into the pathologic correlates of biomarkers, as well as how biomarkers may be used for diagnosis and prognosis (2531). However, there has been no previous quantitative comparison of the literature regarding biomarkers’ discriminative abilities in specific clinical situations. Here, we compare existing studies on the discriminative abilities of serum biomarkers for four commonly studied clinical situations: detecting concussion, predicting intracranial damage after mTBI, predicting delayed recovery after mTBI, and predicting adverse outcome after sTBI.[…]

 

Continue —-> Frontiers | Blood Biomarkers for Traumatic Brain Injury: A Quantitative Assessment of Diagnostic and Prognostic Accuracy | Neurology

Figure 2. Anatomical locations of potential TBI biomarkers. The biomarkers included in this schematic all rated as “good” (AUC=0.800.89) or better for any of the four clinical situations studied (detecting concussion, predicting intracranial damage after concussion, predicting delayed recovery after concussion, and predicting adverse outcome after severe TBI). Biomarkers with a pooled AUC <0.8 are not shown. 1Also found in adipose tissue; 2synthesized in cells of stomach and pancreas; may regulate HPA axis; 3found mostly in pons; 4also found extracellularly; 5lectin pathway of the complement system; 6also found in endothelial cells. BBB, blood brain barrier. ECM, Extracellular matrix. Image licensed under Creative Commons Attribution-ShareAlike 4.0 International license. https://creativecommons.org/licenses/by-sa/4.0/deed.en. See Supplementary Material for image credits and licensing.

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[Abstract] Efficacy and Harms of Pharmacological Interventions for Neurobehavioral Symptoms in Post-Traumatic Amnesia after Traumatic Brain Injury: A Systematic Review

Many individuals in post-traumatic amnesia (PTA) following traumatic brain injury (TBI) experience neurobehavioral symptoms (NBS) in addition to disorientation and amnesia. These symptoms are associated with low rehabilitation engagement, self-inflicted harm, and risk of violence. The aim of this systematic review was to evaluate the efficacy and harms of pharmacological interventions for NBS in PTA following TBI in adults. Studies in English published before December 2017 were reviewed. Six databases were searched, with additional hand searching of key journals, clinical trials registries, and international drug regulators. Evidence quality was assessed using Joanna Briggs Institute Critical Appraisal Instruments. Thirteen studies were identified: three randomized controlled trials (RCTs), three cohort studies, and seven case series. In the RCTs, neither amantadine nor sertraline reduced NBS. Less rigorous studies reported reduced NBS in patients administered haloperidol, ziprasidone, carbamazepine, amitriptyline, desipramine, and varied neuroleptics. There is a paucity of well-designed, adequately powered and controlled studies of pharmacological interventions for NBS in PTA. More research is needed to provide evidence-based treatment recommendations and improve care.

 

via Efficacy and Harms of Pharmacological Interventions for Neurobehavioral Symptoms in Post-Traumatic Amnesia after Traumatic Brain Injury: A Systematic Review | Journal of Neurotrauma

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[WEB SITE] The Comparison Trap | BrainLine

The Comparison Trap Caregiving After Brain Injury, Norma Myers

We can all relate to being guilty of spinning around in the dizzying comparison trap. Whether it’s love, family, career, financial, fashion, weight or cosmetic, somewhere along the line, we have compared ourselves to others. With the presence of social media, this trap has become even more intrusive.

From the moment we received the life-changing news of Aaron and Steven’s car accident, the comparison trap began. Aaron didn’t survive the accident that left Steven with a severe Traumatic Brain Injury (TBI). While the comparison trap from the loss of Aaron would set in later, it immediately bombarded us during Steven’s recovery.

Of all comparisons we thought we would face as parents, nothing prepared our ears to absorb the speech that began: don’t compare your child’s TBI progress to another survivor. A wonderful physician, who is now a friend, spoke those words to us. He then proceeded to inform us, “In a line-up of 10 TBI survivors, you would witness 10 different outcomes.” I did not want my son in a TBI line up or any part of the TBI community. All I wanted was to be able to turn back the calendar to August 13, 2012, and plan a totally different Sunday for our intact family of 4, a day close to home, together.

During Steven’s roller-coaster recovery, we were reminded often, felt like hourly, that with the severity of Steven’s injuries the recovery road was long, we should not get our hopes up. Really? Telling parents not to get their hopes up about their child’s survival was the same as telling us not to take our next breath! Of course, we were going to hope, pray, and never give up.

We admit, despite celebrating Steven’s recovery, we did fall into the dismal comparison trap.

Why is Steven’s rehab roommate already walking?

His accident was as severe as Steven’s; how did he escape a craniectomy and the helmet?

How did she escape the epilepsy curse?

These comparisons led me to wonder if I tapped into all available resources for Steven’s recovery?

As shock eventually lifted, we realize that some of our justifications for comparing were due to our lack of knowledge about TBI. How could we not compare? And while we have heard every lecture on not asking why, it’s human nature to ask, “Why?”

As my heart began to absorb the reality of Aaron’s death, I was faced with new comparisons. When it comes to Aaron’s life, it’s not all about comparisons; it’s more about mynatural mom instinct wondering what Aaron’s life would look like today, a mother’s shattered heart longing for what should have been.

Would Aaron be married?

Would we be grandparents?

Where would Aaron be in his career?

What would Aaron’s big trophy be this hunting season?

While I acknowledge that people mean well, and do not know what to say, the comparison that continues to leave me speechless is comparing child loss to losing a parent or a grandparent. Trust me, I have also experienced those deep losses, but it’s unequivocally not the same, it’s just not.

Lessons I learned from comparing

  • Seek connection, not comparisons. It’s most rewarding to spend time with those that nourish relationships, with those who see the real you.
  • By focusing on the good things in my life, I’m less likely to obsess about what I lack.
  • Comparisons can be never-ending and exhausting. The temptation to compare is as near as my next chat with a friend, a trip to the store, or check-in on social media. I must not get lost in others’ lives and forget to enjoy my own.
  • By shifting my focus, a comparison can turn into inspiration. Being inspired and learning from others can create happiness instead of misery.
  • When life is lived intentionally and thoughtfully, the comparison game becomes less attractive.
  • If I waste time comparing myself to others, I will rob myself of gratitude, joy, and fulfillment.
  • Even when it feels impossible, dig deep, find the courage to celebrate who you are, underneath the messiest of messes, there’s much to celebrate, we are each entirely unique.

When I find myself being drawn in as a pawn in the comparison game, I don’t beat myself up, I just say no! I refuse to stay in the game. After all, it’s not about comparisons, it’s about living for the ones I love and for those that need and love me. Instead of evaluating those in my life; past and present, I will celebrate them. I refuse to get lost in others idealizedlives, I will focus on being grateful for my life; right here, right now; a priceless lesson that Aaron taught me and one that I and the two men in my life attempt to remind each other of daily.

 

via The Comparison Trap | BrainLine

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[Abstract] Evaluation of a 12-month lifestyle intervention by individuals with traumatic brain injury.

Abstract

Weight gain and inactivity are common problems for individuals living with a traumatic brain injury (TBI). Yet, interventions to support a healthy lifestyle specific to individuals with TBI are lacking. The purpose of this study was to complete a program evaluation of a 12-month evidence-based healthy lifestyle intervention adapted for people with a TBI. Eighteen participants completed a brief interview after the yearlong intervention to determine their perceptions of the program effectiveness as well as barriers and facilitators in making lifestyle changes. Participants reported staff, tracking of dietary and activity behavior, and in-person meetings as most helpful aspects. Lack of motivation and difficulty preparing healthy meals were the primary barriers to a healthy lifestyle. Qualitative data revealed five themes that influenced healthy behaviors, including (1) self-regulation, (2) environmental resources, (3) knowledge of health behaviors, (4) TBI-related impairment and comorbidities, and (5) social support. Results suggest that future iterations of the healthy lifestyle intervention should emphasize self-regulation activities; require tracking of dietary and activity behaviors across 12 months; provide concurrent support for individual motivation issues; provide prepared meals; utilize web-based, telephonic, or hybrid approaches to delivery; further simplify the curriculum and learning tools; and include caregivers and peer accountability partners. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

 

via Evaluation of a 12-month lifestyle intervention by individuals with traumatic brain injury. – PubMed – NCBI

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[WEB SITE] Traumatic Brain Injury Resource Guide – Brain Injury News Feb 1, 2018 to April 5, 2019

Brain Injury News

Date Title
04/05/2019 Mental health issues often progress after brain injury
04/04/2019 Head injuries in soccer
04/03/2019 Researchers discover gene suppressing stroke and brain injury recovery
04/02/2019 8 Warning Signs That a Stroke Is Coming On – Look for Little Things
04/01/2019 Near-infrared energy used as therapy during recovery of traumatic brain injury
03/29/2019 Behavioral markers of recovery of consciousness after severe brain injury
03/28/2019 These concussion-preventing bike helmets mimic the brain’s protective fluid
03/27/2019 Scientists discover unique tau filament structures in head-injury associated dementia
03/26/2019 New study reshapes understanding of how the brain recovers from injury
03/25/2019 Fewer boys are suffering head injuries, but rate rises for girls
03/22/2019 Risk of attempted suicide among adolescents and young adults with traumatic brain injury
03/21/2019 Mild traumatic brain injury and psychopathology in adolescence
03/20/2019 New traumatic brain injury blood test approved by FDA
03/19/2019 Football, soccer lead to the most brain injuries in kids
03/18/2019 New approach to stroke treatment could minimize brain damage
03/15/2019 Researchers outline the role of a deep brain structure in concussion
03/14/2019 Scientists teach machines to predict recovery time from sports-related concussions
03/13/2019 The contribution of social support, professional support, and financial hardship to family caregiver life satisfaction after traumatic brain injury
03/12/2019 Decreased risk of dementia among patients with traumatic brain injury receiving acupuncture treatment
03/11/2019 Cognitive reserve protects against memory decrements associated with neuropathology
03/08/2019 Brain injury rampant among domestic violence survivors
03/07/2019 Estimated life-time savings in the cost of ongoing care following specialist rehabilitation for severe traumatic brain injury
03/06/2019 Should we assess pituitary function in children after a mild traumatic brain injury?
03/05/2019 Global outcome trajectories up to 10 years after moderate to severe traumatic brain injury
03/04/2019 Sex differences in traumatic brain injury
03/01/2019 Factors contributing to parent-child interaction quality following mild traumatic brain injury in early childhood
02/28/2019 March is brain injury awareness month
02/27/2019 Brain injuries in women prisoners are linked to mental illness and reoffending
02/26/2019 Nixing neuron receptor improves recovery from brain injury
02/25/2019 Blood test being developed to better diagnose traumatic brain injuries
02/22/2019 Alcohol has a dose-dependent effect on the outcomes of traumatic brain injury patients
02/21/2019 ‘I hit my head.’ Let’s talk about traumatic brain injury
02/20/2019 Amantadine may be effective treatment for headaches after traumatic brain injury
02/19/2019 Traumatic brain injuries linked to epilepsy development
02/18/2019 Amantadine may be effective treatment for headaches after traumatic brain injury
02/15/2019 New study shows chronic head injuries lead to mental health issues
02/14/2019 Pill that reverses brain damage could be on the horizon
02/13/2019 Association of concussion with the risk of suicide
02/12/2019 Drug combo makes neurons to replace damaged ones
02/11/2019 Nearly 65% of prisoners at women’s jail ‘show signs of brain injury’
02/08/2019 Concussed adolescent athletes ‘prescribed’ aerobic exercise recovered faster
02/07/2019 New monitoring software suggests sub-concussive blows cause brain function changes
02/06/2019 Cancer drug shows promise in mitigating concussive brain injuries
02/05/2019 Mild traumatic brain injury linked to higher risk of PTSD, depression
02/04/2019 Wrestling with uncertainty after mild traumatic brain injury
02/01/2019 The frequency and the diagnosis of pituitary dysfunction after traumatic brain injury
01/31/2019 Self-awareness following a traumatic brain injury in childhood
01/30/2019 Concussion and its consequences
01/29/2019 Pharmacotherapy effectiveness in treating depression after traumatic brain injury
01/28/2019 Pituitary dysfunction due to sports-related traumatic brain injury
01/25/2019 How concussions may lead to epilepsy
01/24/2019 Quality of life in adolescents recovering from sports-related concussion
01/23/2019 Smartphone app that can rapidly monitor the brain for signs of concussion
01/22/2019 Brain vital signs capture undetected impairments in ice hockey players with concussions
01/21/2019 Life after my traumatic brain injury will never be the same again, but I’m taking it one step at a time
01/18/2019 Traumatic brain injury and psychiatric co-morbidity
01/17/2019 Employment probability trajectories up to 10 years after moderate-to-severe traumatic brain injury
01/16/2019 Sleep-wake disturbances in childhood traumatic brain injury
01/15/2019 Predictors of community integration following traumatic brain injury
01/14/2019 Moderate to severe gambling problems and traumatic brain injury
01/11/2019 Behavioral therapies may treat headache and post-concussive symptoms
01/10/2019 Childhood socioeconomic status predicts cognitive outcomes across adulthood following traumatic brain injury
01/09/2019 Prevalence of medical and psychiatric comorbidities following traumatic brain injury
01/08/2019 Forget baseline tests, eye-tracking brings greater clarity to concussion diagnosis
01/07/2019 Effect of low frequency repetitive transcranial magnetic stimulation on depression and cognition of patients with traumatic brain injury
01/04/2019 I suffered from 2 traumatic brain injuries, but it took 13 years to get a diagnosis
01/03/2019 Traumatic brain injury bill set to become federal law
01/02/2019 Are traumatic brain injuries associated with criminality after taking account of childhood family Social Status and Disruptive Behaviors?
12/31/2018 Tackle football poses a grave risk to young athletes
12/28/2018 Intimate partner violence and traumatic brain injury: An “invisible” public health epidemic
12/27/2018 Effects of cerebrolysin on functional outcome of patients with traumatic brain injury
12/26/2018 Understanding repetitive head impacts in sports
12/21/2018 Researchers find lasting impact of concussions on young adults
12/20/2018 Computers determine states of consciousness
12/19/2018 Study makes significant findings related to traumatic brain injury
12/18/2018 There may be a surprising link between depression and concussions in kids who play football
12/17/2018 A new strategy for brain regeneration after stroke
12/14/2018 Dialysis patients at risk of progressive brain injury
12/13/2018 Experts address sleep disorders following traumatic brain injury
12/12/2018 ‘Before, I was quite a shy person’: life after brain damage
12/11/2018 Rethinking treatment of traumatic brain injuries among children with disabilities
12/10/2018 Rural youth with mild head injuries face higher medical costs but get less care
12/07/2018 Kids with concussions can phase in exercise, screen time sooner than before
12/06/2018 Youth football changes nerve fibers in brain
12/05/2018 Commonly used concussion test useful in confirming—but not making—diagnosis for pro athletes
12/04/2018 Brain changes seen in MRIs of young football players
12/03/2018 How I got my life back on track after a brain injury
11/30/2018 EEG response to speech identifies severe brain injury patients with preserved cognition
11/29/2018 The search for a pill that treats concussions
11/28/2018 New way to ID cognitively aware yet unresponsive people with severe brain injury
11/27/2018 Head injuries lead to serious brain diseases- Here’s all you need to know
11/26/2018 Reprogrammed cells could tackle brain damage
11/21/2018 Suicide after concussion rare, but risk is higher
11/20/2018 New concussion recommendations for kids
11/19/2018 Researchers find further link between a-fib, brain injury, and possible neurodegeneration
11/16/2018 Mild blast forces cause brain pathology and deficits, despite lack of macroscopic damage
11/15/2018 Blood test may one day help track concussion recovery
11/14/2018 One type of brain cell might hold key to inflammation after head injury
11/13/2018 Traumatic Brain Injury Model Systems Centers mark 30 years of research
11/12/2018 New research shows symptom improvement after concussion in children varies
11/09/2018 Good sleep quality encourages better recovery after sport-related concussion
11/08/2018 Traumatic brain injuries can lead to long-term neurological and psychiatric disorders
11/07/2018 Evidence of brain injuries present in football players at young ages
11/06/2018 Socioeconomic status affects outcomes after traumatic brain injury
11/05/2018 Transcranial magnetic stimulation for treatment of depression in a patient with traumatic brain injury
11/02/2018 Changes in growth factor levels over a 7-day period predict the functional outcomes of traumatic brain injury
11/01/2018 pituitary dysfunction following traumatic brain injury
10/31/2018 Gender differences in employment and economic quality of life following traumatic brain injury
10/30/2018 Concussion and college football: how many hits to the head is too much?
10/29/2018 Cerebral atrophy following traumatic brain injury
10/26/2018 Globally recognised treatment to cool the brain after a head injury does not reduce the risk of permanent damage
10/25/2018 Feed-forward and feed-back mechanisms underlie the relationship between traumatic brain injury and gut microbiota
10/24/2018 With dangers of everyday concussions revealed, scientists race to find solutions
10/23/2018 Sleep disruption following mild traumatic brain injury
10/22/2018 Quality of life and symptom burden 1 month after concussion in children and adolescents
10/19/2018 A systematic review and meta-analysis of return to work after mild Traumatic brain injury
10/18/2018 Kids’ concussion symptoms may persist for a year
10/17/2018 Sugar, a “sweet” tool to understand brain injuries
10/16/2018 Neck device shows promise in protecting the brain of female soccer players
10/15/2018 Patterns of pituitary dysfunction three months or more after traumatic brain injury
10/12/2018 Are eyes a window to diagnosing acute concussion in youth?
10/11/2018 Scientists design new methodology of motor assessment for patients with acquired brain injury
10/10/2018 Every cell has a story to tell in brain injury
10/09/2018 Concussion history and cognitive function
10/08/2018 Traumatic brain injury as an independent risk factor for problem gambling
10/05/2018 Prevalence of TBI 2.5 percent among U.S. children
10/04/2018 What happens to the brain after a traumatic injury?
10/03/2018 Researchers discover possible cause for Alzheimer’s and traumatic brain injury
10/02/2018 Neurobehavioral symptoms predictive of employment outcome after traumatic brain injury
10/01/2018 White matter repair and traumatic brain injury
09/28/2018 1 in 6 Americans over 40 has been knocked unconscious
09/27/2018 Traumatic brain injury as an independent risk factor for problem gambling
09/26/2018 New attention being paid to emotional toll of traumatic brain injuries
09/25/2018 Brain recovery: Activity, not rest, may speed recovery after brain injury
09/24/2018 Researchers find children experience concussion symptoms three times longer than adults
09/21/2018 Life after concussion
09/20/2018 For kids with concussions, less time alone in a dark room
09/19/2018 An improvement in outcome for patients with severe traumatic brain injury
09/18/2018 Clinical characteristics of patients with bipolar disorder and premorbid traumatic brain injury
09/17/2018 What happens inside an injured brain?
09/14/2018 Outcomes of subjective sleep-wake disturbances 20 years after traumatic brain injury in childhood
09/13/2018 Indicators of long-term return to work after severe traumatic brain injury
09/12/2018 The CDC just released new concussion guidelines for kids
09/11/2018 New guidelines for traumatic brain injury — Built with input from rehabilitation professionals
09/10/2018 Benefits of methylphenidate for long-term attention problems after traumatic brain injury in childhood
09/07/2018 Concussions loosen insulation around brain cells
09/06/2018 The effect of antidepressants on depression after traumatic brain injury
09/05/2018 Helmets may not protect skiers from traumatic brain injury
09/04/2018 Device aims to detect concussion symptoms in the blink of an eye
08/31/2018 Different, but still whole: A young scientist reflects on his journey back from a brain injury
08/30/2018 Traumatic brain injury recovery via electrically stimulating neuron cells
08/29/2018 Head and neck positioning affects concussion risk
08/28/2018 Protecting against brain injuries
08/27/2018 Diagnosed: Under-reported brain injuries and their lasting effects
08/24/2018 Traumatic brain injury and incarceration: Ending a vicious cycle
08/23/2018 Association between traumatic brain injury and risk of suicide
08/22/2018 Genetic risk for ADHD not linked to ADHD symptoms after TBI
08/21/2018 How concussion stresses the heart, to protect the brain
08/20/2018 Immune Tolerance Therapy: A new method for treatment of traumatic brain injury
08/17/2018 Marriage breakdown after brain injury
08/16/2018 Suicide risk higher in people with brain injury
08/15/2018 ognitive training can reduce depressive symptoms in individuals with traumatic brain injury
08/14/2018 Researchers link residential characteristics with productivity one year after brain injury
08/13/2018 Serum magnesium as a marker of neurological outcome in traumatic brain injury patients
08/10/2018 Employment stability in the first 5 years after traumatic brain injury
08/09/2018 Concussion symptoms: take them seriously
08/08/2018 How severe brain injury might trigger dementia
08/07/2018 Head injury risk higher for female soccer players
08/06/2018 Scientists develop blood-drop test for concussion
08/03/2018 Finding lost emotions after brain injury
08/02/2018 Poor sleep is linked to impeded recovery from traumatic brain injury
08/01/2018 Sleep disturbance in children with traumatic brain injury compared with children with orthopedic injury
07/31/2018 The relationship between mental health and quality of life in children with traumatic brain injury three months after the injury
07/30/2018 Traumatic brain injury: Discovery of two molecules could lead to new drug treatments
07/27/2018 Study supports blood test to help diagnose brain injury
07/26/2018 ADHD tied to increased concussion risk for kids
07/25/2018 Developmental outcomes after traumatic brain injury in young children: Are infants more vulnerable than toddlers?
07/24/2018 Acupuncture for treatment of persistent disturbed sleep: A randomized clinical trial in veterans with mild traumatic brain injury and post-traumatic stress disorder
07/23/2018 8-year outcome after severe traumatic brain injury
07/20/2018 Scientists hunt for a test to diagnose chronic brain injury in living people
07/19/2018 TBI biomarker shows promise to support rapid damage evaluation & predict outcomes
07/18/2018 Exosomes in blood indicate mild TBI
07/17/2018 Concussion may bring greater risks for athletes with ADHD
07/16/2018 Emotional reserve and prolonged post-concussive symptoms and disability
07/13/2018 Concussion pill shows promise in pre-clinical pilot study
07/12/2018 Do mild concussions increase the risk of developing Parkinson’s disease?
07/11/2018 Obesity and overweight linked to long-term health problems after traumatic brain injury
07/10/2018 People with traumatic brain injury are at increased risk of dementia
07/09/2018 Sex-based differences in affective and cognitive empathy following severe traumatic brain injury
07/06/2018 Time-based prospective memory in children and adolescents with traumatic brain injury
07/05/2018 Psychological resilience is associated with participation outcomes following traumatic brain injury
07/03/2018 Starting physical therapy earlier may benefit adolescents with concussion
07/02/2018 Scientists identify immune cells that remove degenerating neurons after brain injury
06/29/2018 The influence of yoga on individuals with traumatic brain injury related to sleep and mood
06/28/2018 Clinical validation of S100B in the management of a mild traumatic brain injury
06/27/2018 Barriers and enablers to aligning rehabilitation goals to patient life roles following acquired brain injury
06/26/2018 Deficits in saccades and smooth-pursuit eye movements in adults with traumatic brain injury
06/25/2018 ‘Antifreeze’ molecules may stop and reverse damage from brain injuries
06/22/2018 Simple cognitive task after brain injury improves memory function
06/21/2018 Melatonin as a treatment after traumatic brain injury
06/20/2018 Disability and quality of life 20 years after traumatic brain injury
06/19/2018 One-year outcome following brain injury: a comparison of younger versus elderly major trauma patients
06/19/2018 Concussion symptoms vary depending on your sex, & here’s why it matters
06/18/2018 Diffuse axonal injury (DAI) in moderate to severe head injured patients: Pure DAI vs. non-pure DAI
06/18/2018 Targeting inflammation may protect and restore the brain after stroke
06/15/2018 The incidence of anosmia after traumatic brain injury
06/14/2018 Characterization of balance control after moderate to severe traumatic brain injury
06/13/2018 Sedentary behavior predicts headache pain following mild traumatic brain injury
06/12/2018 The relationship between agitation and impairments of orientation and memory during the PTA period after traumatic brain injury
06/11/2018 Relationship between hispanic nativity, residential environment, and productive activity among individuals with traumatic brain injury
06/08/2018 Traumatic brain injury and the risk for subsequent crime perpetration
06/07/2018 Predictors of neuropsychological outcome after pediatric concussion
06/07/2018 Scientists work to dissolve the NETs that worsen TBI damage
06/06/2018 Risk of depression following traumatic brain injury in a large national sample
06/05/2018 Traumatic brain injury history and progression from mild cognitive impairment to Alzheimer disease
06/04/2018 Efficacy of the resilience and adjustment intervention after traumatic brain injury
06/01/2018 Obsessive-compulsive disorder due to traumatic brain injury
05/31/2018 Melatonin as a therapy for traumatic brain injury
05/31/2018 After a concussion, waiting for the sense of smell to return
05/30/2018 Positive psychology perspective on traumatic brain injury recovery and rehabilitation
05/30/2018 Traumatic brain injury without loss of consciousness associated with increased dementia risk
05/29/2018 Role of magnetic resonance spectroscopy for prognosis of patients with traumatic brain injury
05/24/2018 Assessing the longer-term effects of mild traumatic brain injury on self-reported driving ability
05/24/2018 Strategic training may cut symptoms of depression post-brain injury
05/23/2018 Onset, time course and prediction of spasticity after stroke or traumatic brain injury
05/23/2018 Unmet therapy needs common in children with traumatic brain injury
05/22/2018 The effectiveness of physical exercise as an intervention to reduce depressive symptoms following traumatic brain injury
05/22/2018 How can we help children with brain injuries transition back to school?
05/21/2018 The experience of return to work in individuals with traumatic brain injury
05/18/2018 Amantadine did not positively impact cognition in chronic traumatic brain injury
05/17/2018 Frequency and prognostic factors of olfactory dysfunction after traumatic brain injury
05/17/2018 Even mild concussion tied to greater dementia risk later
05/16/2018 Methylphenidate-mediated motor control enhancement in patients with traumatic brain injury
05/16/2018 A life shattered by brain injury
05/15/2018 Outcomes in nursing home patients with traumatic brain injury
05/15/2018 Changes to tiny blood vessels may help diagnose traumatic brain injuries
05/14/2018 Brain plasticity and modern neurorehabilitation technologies
05/14/2018 Acute and chronic changes in myelin following mild traumatic brain injury
05/11/2018 Extra practice outside therapy sessions to maximize training opportunity during inpatient rehabilitation after traumatic brain injury
05/11/2018 Playing football young may mean earlier cognitive, emotional problems
05/10/2018 A case report of guardian-consent forced paliperidone palmitate for behavioral disturbance due to traumatic brain injury
05/10/2018 How injuries change our brain and how we can help it recover
05/09/2018 Psychological well-being in individuals living in the community with traumatic brain injury
05/09/2018 One concussion could increase risk of Parkinson’s disease
05/08/2018 Fatigue and associated factors in traumatic brain injury and its correlation with insomnia and depression
05/08/2018 Soccer heading — not collisions — cognitively impairs players
05/07/2018 Prediction of persistent post-concussion symptoms following mild traumatic brain injury
05/07/2018 The scientific reason a brain injury can change your personality
05/04/2018 The experience of a recreational camp for families with a child or young person with acquired brain injury
05/04/2018 Blood biomarkers may allow easier detection, confirmation of concussions
05/03/2018 Traumatic brain injury-related symptoms reported by parents: clinical, imaging, and host predictors in children with impairments in consciousness <24 hours
05/03/2018 Many U.S. kids with brain injuries not getting needed rehab
05/02/2018 Plasma metabolomic biomarkers accurately classify acute mild traumatic brain injury from controls
05/02/2018 Blood test reveals progress of concussion recovery in athletes
05/01/2018 Is electroconvulsive therapy a treatment for depression following traumatic brain injury?
05/01/2018 Starting aerobic exercise soon after concussion improves recovery time
04/30/2018 Behavioral interventions for inappropriate sexual behavior in individuals with acquired brain injury
04/30/2018 Does concussion recovery and symptom severity differ between men and women?
04/27/2018 Fear avoidance and clinical outcomes from mild traumatic brain injury
04/27/2018 Research suggests that kids with brain injuries have a higher risk of ADHD
04/26/2018 Unmet rehabilitation needs after hospitalization for traumatic brain injury
04/26/2018 Traumatic brain injury—the unseen impact of domestic violence
04/25/2018 Effects of electrical stimulation in people with post-concussion syndromes
04/25/2018 Researchers chart a new way to look at concussion
04/24/2018 Acute prediction of outcome and cognitive-communication impairments following traumatic brain injury: the influence of age, education and site of lesion
04/24/2018 Scientists watch in real time as the lining of the brain heals itself after traumatic injury
04/23/2018 Behavioral and neurophysiological abnormalities during cued continuous performance tasks in patients with mild traumatic brain injury
04/23/2018 Reversing brain injury in newborns and adults
04/19/2018 Understanding divergent trajectories in pediatric patients with moderate to severe traumatic brain injury
04/19/2018 Receptor that feels the heat of a red chili pepper may be target for TBI recovery
04/18/2018 Behavioral and brain imaging changes in patients receiving bright light therapy following a mild traumatic brain injury
04/18/2018 Brain injuries increase dementia risk, study finds
04/17/2018 Distinct 6-Month functional outcome trajectories and predictors after traumatic brain injury
04/17/2018 Scientists have discovered a new stem cell that could heal brain damage
04/16/2018 Neuroendocrine abnormalities following traumatic brain injury: An important contributor to neuropsychiatric sequelae
04/16/2018 Concussion increases the risk of prolonged headache woes
04/13/2018 MLC901 (NeuroAiD II™ ) for cognition after traumatic brain injury
04/13/2018 Multiple, smaller head blows can be worse than concussions
04/12/2018 The impact of cultural background on outcome following traumatic brain injury
04/12/2018 Waking up “sleeping” stem cells in the brain could improve its ability to repair injury
04/11/2018 Perceived stigma and its association with participation following traumatic brain injury
04/11/2018 Could this drug help the brain recover after a stroke?
04/10/2018 Trajectories in health recovery in the 12 months following a mild traumatic brain injury in children
04/09/2018 Interpersonal stressors and resources as predictors of adolescent adjustment following traumatic brain injury
04/06/2018 Effects of web-based parent training on caregiver functioning following pediatric traumatic brain injury
04/05/2018 The association of rehospitalization with participation 5 years after traumatic brain injury
04/05/2018 Gene therapy may help brain heal from stroke
04/04/2018 Exercise rehabilitation attenuates cognitive deficits with traumatic brain injury
04/04/2018 Prosthetic memories help brain injury patients with short-term recall
04/03/2018 Altruistic decisions following penetrating traumatic brain injury
04/02/2018 Imagining the future in children with severe traumatic brain injury
03/30/2018 Depression in the first year after traumatic brain injury
03/29/2018 Fatigue following pediatric acquired brain injury and its impact on functional outcomes
03/28/2018 Secondary Attention-Deficit/Hyperactivity disorder in children and adolescents 5 to 10 years after traumatic brain injury
03/27/2018 Predictors of post-discharge seizures in children with traumatic brain injury
03/27/2018 Kids with severe brain injuries may develop ADHD
03/26/2018 Longitudinal recovery of executive control functions after moderate-severe traumatic brain injury
03/23/2018 Use of an errorless learning approach in a person with concomitant traumatic spinal cord injury and brain injury
03/22/2018 Long-term effects of mild traumatic brain injuries to oculomotor tracking performances and reaction times to simple environmental stimuli
03/21/2018 Relax while you rehabilitate: A pilot study integrating a novel, yoga-based mindfulness group intervention into a residential military brain injury rehabilitation program
03/20/2018 Association of post-traumatic stress symptom severity with health-related quality of life and self-reported functioning across 12-months after severe traumatic brain injury
03/19/2018 Persistent symptoms and activity changes three months after mild traumatic brain injury
03/16/2018 Interventions to enhance coping after traumatic brain injury
03/15/2018 Is there a correlation between family functioning and functional recovery in patients with acquired brain injury?
03/14/2018 Efficacy of a micro-prompting technology in reducing support needed by people with severe acquired brain injury in activities of daily living
03/13/2018 Assessment of recovery following pediatric traumatic brain injury
03/12/2018 Magnesium administration after experimental traumatic brain injury improves decision-making skills
03/09/2018 Hearing loss after traumatic brain injury
03/08/2018 Persistent symptoms and activity changes three months after mild traumatic brain injury
03/07/2018 Aerobic exercise for adolescents with prolonged symptoms after mild traumatic brain injury
03/07/2018 Girls’ concussion symptoms last twice as long as those in boys
03/06/2018 Visual problems associated with traumatic brain injury
03/05/2018 Lifelong behavioral and neuropathological consequences of repetitive mild traumatic brain injury
03/02/2018 Cognitive function and participation in children and youth with mild traumatic brain injury two years after injury
03/01/2018 Trajectory of functional independent measurements during first 5-years following traumatic brain injury
02/28/2018 Safety, tolerability, and effectiveness of dextromethorphan for pseudobulbar affect following traumatic brain injury
02/27/2018 Blood biomarkers in pediatric mild traumatic brain injury
02/26/2018 Cerebral blood vessel damage in traumatic brain injury
02/23/2018 Long-term consequences of traumatic brain injury in bone metabolism
02/23/2018 All children do not follow the same path to concussion recovery
02/22/2018 Traumatic brain injury, sleep disorders, and psychiatric disorders: An underrecognized relationship
02/22/2018 Positive psychology helps brain injury survivors recover with a better outlook on life
02/21/2018 Virtual reality for pediatric traumatic brain injury rehabilitation
02/21/2018 Genetic risk score could help predict patient’s quality of life after traumatic brain injury
02/20/2018 A review of sleep disturbances following traumatic brain injury
02/20/2018 FDA approves first blood test to help diagnose brain injuries
02/16/2018 Recovery following pediatric traumatic brain injury
02/15/2018 The effects of timing and intensity of neurorehabilitation on functional outcome after traumatic brain injury
02/14/2018 Effectiveness of occupation and activity-based interventions for people with traumatic brain injury
02/13/2018 Traumatic brain injury history is associated with an earlier age of dementia onset
02/13/2018 Women more likely to suffer sports-related concussions
02/12/2018 Effect of high-frequency repetitive transcranial magnetic stimulation on chronic central pain after mild traumatic brain injury
02/09/2018 Predicting the trajectory of participation after traumatic brain injury
02/09/2018 A tiny pulse of electricity can help the brain form lasting memories
02/08/2018 A systematic review and meta-analysis of sleep architecture and chronic traumatic brain injury
02/07/2018 Changes in oculomotor function in young adults with mild traumatic brain injury
02/06/2018 Transcranial ultrasound stimulation improves long-term functional outcomes and protects against brain damage in traumatic brain injury
02/06/2018 Could a vaccine protect football players from concussion?
02/02/2018 Impaired theory of mind in adults with traumatic brain injury
02/01/2018 Headache following head injury: a population-based longitudinal cohort study
02/01/2018 Concussions tied to rise in dementia risk decades later
01/31/2018 Effects of fatigue, driving status, cognition, and depression on participation in adults with traumatic brain injury
01/30/2018 Impact & blast traumatic brain injury: Implications for therapy
01/29/2018 The potential of stem cells in treatment of traumatic brain injury
01/26/2018 Efficacy of melatonin for sleep disturbance following traumatic brain injury
01/25/2018 A case of traumatic brain injury presenting with musical hallucinations
01/24/2018 Depression: The often overlooked sequela of head trauma
01/23/2018 The association between premorbid conditions in school-aged children with prolonged concussion recovery
01/22/2018 Risk of erectile dysfunction after traumatic brain injury
01/22/2018 Repeated head hits, not just concussions, may lead to a type of chronic brain damage
01/19/2018 Association between bipolar disorder and subsequent traumatic brain injury
01/19/2018 Brain protein changes could explain how concussions affect patients
01/18/2018 Traumatic Brain Injury: A potential cause of violent crime?
01/17/2018 Effect of age and sex on hospital readmission in traumatic brain injury
01/17/2018 Research uncovers new link between head trauma, CTE, and ALS
01/16/2018 Cognitive behavioral intervention compared to telephone counseling early after mild traumatic brain injury
01/15/2018 Effects of neurofeedback on the short-term memory and continuous attention of patients with moderate traumatic brain injury
01/12/2018 Growing literature but limited evidence: A systematic review regarding prebiotic and probiotic interventions for those with traumatic brain injury
01/12/2018 Team finds that brain implants can rely on more than neurons to function
01/11/2018 A retrospective analysis of the relationship between facial injury and mild traumatic brain injury
01/10/2018 Psychosocial and executive function recovery trajectories one year after pediatric traumatic brain injury: The influence of age and injury severity
01/09/2018 Concussion in adolescence and risk of multiple sclerosis
01/08/2018 Dizziness-related disability following mild-moderate traumatic brain injury
01/05/2018 Predicting fatigue 12 months after child traumatic brain injury
01/04/2018 The prevalence of traumatic brain injury, comorbid anxiety and other psychiatric disorders in an outpatient child and adolescent mental health service
01/03/2018 Does the fear avoidance model explain persistent symptoms after traumatic brain injury?
01/02/2018 Self-awareness four years after severe traumatic brain injury

via Traumatic Brain Injury Resource Guide – Brain Injury News

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[Abstract] Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014 – Archives of Physical Medicine and Rehabilitation

Abstract

Objective

To conduct an updated, systematic review of the clinical literature, classify studies based on the strength of research design, and derive consensual, evidence-based clinical recommendations for cognitive rehabilitation of people with TBI or stroke.

Data Sources

Online Pubmed and print journal searches identified citations for 250 articles published from 2009 through 2014.

Study Selection

186 articles were selected for inclusion after initial screening. 50 articles were initially excluded (24 healthy, pediatric or other neurologic diagnoses, 10 non-cognitive interventions, 13 descriptive protocols or studies, 3 non-treatment studies). 15 articles were excluded after complete review (1 other neurologic diagnosis, 2 non-treatment studies, 1 qualitative study, 4 descriptive papers, 7 secondary analyses). 121 studies were fully reviewed.

Data Extraction

Articles were reviewed by CRTF members according to specific criteria for study design and quality, and classified as providing Class I, Class II, or Class III evidence. Articles were assigned to 1 of 6 possible categories (based on interventions for attention, vision and neglect, language and communication skills, memory, executive function, or comprehensive-integrated interventions).

Data Synthesis

Of 121 studies, 41 were rated as Class I, 3 as Class Ia, 14 as Class II, and 63 as Class III. Recommendations were derived by CRTF consensus from the relative strengths of the evidence, based on the decision rules applied in prior reviews.

Conclusions

CRTF has now evaluated 491 papers (109 Class I or Ia, 68 Class II, and 314 Class III) and makes 29 recommendations for evidence-based practice of cognitive rehabilitation (9 Practice Standards, 9 Practice Guidelines and 11 Practice Options). Evidence supports Practice Standards for attention deficits after TBI or stroke; visual scanning for neglect after right hemisphere stroke; compensatory strategies for mild memory deficits; language deficits after left hemisphere stroke; social communication deficits after TBI; metacognitive strategy training for deficits in executive functioning; and comprehensive-holistic neuropsychological rehabilitation to reduce cognitive and functional disability after TBI or stroke.

via Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014 – Archives of Physical Medicine and Rehabilitation

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[BLOG POST] 9 promising advances in the management of traumatic brain injury – The Neurology Lounge

 

Traumatic brain injury (TBI) is simply disheartening. It is particularly devastating because it usually affects young people in their prime, with the consequent personal, social, and economic consequences. This blog has previously touched a little on TBI with the post titled Will Smith and chronic traumatic encephalopathy? This was a light-hearted take on concussion in sports, but traumatic brain injury is nothing but a serious burden. So what are the big brains in white coats doing to take down this colossus? Quite a lot it seems. Here, for a taster, are 9 promising advances in the management of traumatic brain injury.

Better understanding of pathology

An amyloid PET imaging study by Gregory Scott and colleagues, published in the journal Neurology, reported a rather surprising link between the pathology seen in long-term survivors of traumatic brain injury, with the pathology seen in Alzheimers disease (AD). In both conditions, there is an increased burden of β-amyloid () in the brain, produced by damage to the nerve axons. The paper, titled Amyloid pathology and axonal injury after brain trauma, however notes that the pattern of  deposition in TBI can be distinguished from the one seen in AD. The big question this finding raises is, does TBI eventually result in AD? The answer remains unclear, and this is discussed in the accompanying editorial titled Amyloid plaques in TBI.

Blood tests to detect concussion

The ideal biomarker for any disorder is one which is easy to detect, such as a simple blood test. A headline that screams Blood test may offer new way to detect concussions is therefore bound to attract attention. The benefits of such a test would be legion, especially if the test can reduce the requirement for CT scans which carry the risks of radiation exposure. This is where glial fibrillary acidic protein (GFAP) may be promising. The research is published in the journal, Academic Research Medicine, with a rather convoluted title, Performance of Glial Fibrillary Acidic Protein in Detecting Traumatic Intracranial Lesions on Computed Tomography in Children and Youth With Mild Head Trauma. The premise of the paper is the fact that GFAP is released into the blood stream from the glial cells of the brain soon after brain injury. What the authors therefore did was to take blood samples within 6 hours of TBI in children. And they demonstrated that GFAP levels are significantly higher following head injury, compared to injuries elsewhere in the body. This sounds exciting, but we have to wait and see where it takes us.

Advanced imaging

Brain Scars Detected in Concussions is the attention-grabbing headline for this one, published in MIT Technology Review. Follow the trail and it leads to the actual scientific paper in the journal Radiology, with a fairly straight-forward title, Findings from Structural MR Imaging in Military Traumatic Brain Injury The authors studied >800 subjects in what is the largest trial of traumatic brain injury in the military. Using high resolution 3T brain magnetic resonance imaging (MRI), they demonstrated that even what is reported as mild brain injury leaves its marks on the brain, usually in the form of white matter hyperintense lesions and pituitary abnormalities. It simply goes to show that nothing is mild when it comes to the brain, the most complex entity in the universe.

Implanted monitoring sensors

Current technologies which monitor patients with traumatic brain injury are, to say the least, cumbersome and very invasive. Imagine if all the tubes and wires could be replaced with microsensors, smaller than grains of rice, implanted in the brain. These would enable close monitoring of critical indices such as temperature and intracranial pressure. And imagine that these tiny sensors just dissolve away when they have done their job, leaving no damage. Now imagine that all this is reality. I came across this one from a CBS News piece titled Tiny implanted sensors monitor brain injuries, then dissolve away. Don’t scoff yet, it is grounded in a scientific paper published in the prestigious journal, Nature, under the title Bioresorbable silicon electronic sensors for the brain. But don’t get too exited yet, this is currently only being trialled in mice.

Drugs to reduce brain inflammation

What if the inflammation that is set off following traumatic brain injury could be stopped in its tracks? Then a lot of the damage from brain injury could be avoided. Is there a drug that could do this? Well, it seems there is, and it is the humble blood pressure drug Telmisartan. This one came to my attention in Medical News Today, in a piece titled Hypertension drug reduces inflammation from traumatic brain injury. Telmisartan seemingly blocks the production of a pro-inflammatory protein in the liver. By doing this, Telmisartan may effectively mitigate brain damage, but only if it is administered very early after traumatic brain injury. The original paper is published in the prestigious journal, Brain, and it is titled Neurorestoration after traumatic brain injury through angiotensin II receptor blockage. Again, don’t get too warm and fuzzy about this yet; so far, only mice have seen the benefits.

Treatment of fatigue

Fatigue is a major long-term consequence of traumatic brain injury, impairing the quality of life of affected subjects in a very frustrating way. It therefore goes without saying, (even if it actually has to be said), that any intervention that alleviates the lethargy of TBI will be energising news. And an intervention seems to be looming in the horizon! Researchers writing in the journal, Acta Neurologica Scandinavica, have reported that Methylphenidate significantly improved fatigue in the 20 subjects they studied. Published under the title Long-term treatment with methylphenidate for fatigue after traumatic brain injury, the study is rather small, not enough to make us start dancing the jig yet. The authors have rightly called for larger randomized trials to corroborate their findings, and we are all waiting with bated breaths.

Treatment of behavioural abnormalities

Many survivors of traumatic brain injury are left with behavioural disturbances which are baffling to the victim, and challenging to their families. Unfortunately, many of the drugs used to treat these behaviours are not effective. This is where some brilliant minds come in, with the idea of stimulating blood stem cell production to enhance behavioural recovery. I am not clear what inspired this idea, but the idea has inspired the paper titled Granulocyte colony-stimulating factor promotes behavioral recovery in a mouse model of traumatic brain injury. The authors report that the administration of G‐CSF for 3 days after mild TBI improved the performance of mice in a water maze…within 2 weeks. As the water maze is a test of learning and memory, and not of behaviour, I can only imagine the authors thought-surely only well-behaved mice will bother to take the test. It is however fascinating that G‐CSF treatment actually seems to fix brain damage in TBI, and it does so by stimulating astrocytosis and microgliosis, increasing the expression of neurotrophic factors, and generating new neurons in the hippocampus“. The promise, if translated to humans, should therefore go way beyond water mazes, but we have to wait and see.

Drugs to accelerate recovery

The idea behind using Etanercept to promote recovery from brain injury sound logical. A paper published in the journal, Clinical Drug Investigation, explains that brain injury sets off a chronic lingering inflammation which is driven by tumour necrosis factor (TNF). A TNF inhibitor will therefore be aptly placed to stop the inflammation. What better TNF inhibitor than Eternacept to try out, and what better way to deliver it than directly into the nervous system. And this is what the authors of the paper, titled Immediate neurological recovery following perispinal etanercept years after brain injury, did. And based on their findings, they made some very powerful claims: “a single dose of perispinal etanercept produced an immediate, profound, and sustained improvementin expressive aphasia, speech apraxia, and left hemiparesis in a patient with chronic, intractable, debilitating neurological dysfunction present for more than 3 years after acute brain injury”. A single patient, mind you. Not that I am sceptical by nature, but a larger study confirming this will be very reassuring.

Neuroprotection

And finally, that elusive holy grail of neurological therapeutics, neuroprotection. Well, does it exist? A review of the subject published in the journal, International Journal of Molecular Sciences, paints a rather gloomy picture of the current state of play. Titled Neuroprotective Strategies After Traumatic Brain Injury, it said “despite strong experimental data, more than 30 clinical trials of neuroprotection in TBI patients have failed“. But all is not lost. The authors promise that “recent changes in experimental approach and advances in clinical trial methodologyhave raised the potential for successful clinical translation”. Another review article, this time in the journal Critical Care, doesn’t offer any more cheery news about the current state of affairs when it says that the “use of these potential interventions in human randomized controlled studies has generally given disappointing results”. But the review, titled Neuroprotection in acute brain injury: an up-to-date review, goes through promising new strategies for neuroprotection following brain injury: these include hyperbaric oxygensex hormones, volatile anaesthetic agents, and mesenchymal stromal cells. The authors conclude on a positive note: “despite all the disappointments, there are many new therapeutic possibilities still to be explored and tested”.

What an optimistic way to end! We are not quite there yet, but these are encouraging steps.

via 9 promising advances in the management of traumatic brain injury | The Neurology Lounge

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[BLOG] Lash & Associates’ Award-Winning Blog site

TBI, ABI, PTSD, Stroke, Concussion Blog Posts!

Lash & Associates’
Award-Winning Blog Site
Is Well Worth A Look

Our large variety of blog articles are keyword searchable, and offer help & encouragement.

Click here to go the our blog site!

No matter what your situation – as a survivor, a clinician, a caregiver, or a family member, our blog site provides a great reference point. Check it out – we’ve got something for most any situation regarding the greater TBI Community!

via Lash & Associates’ Award-Winning Blog site

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[BLOG POST] Intentional Living After TBI – Brain Injury Blog

Intentional Living After TBI

Finding your way after a stroke, ABI, MBI, TBI, Concussion, and related conditions is uncharted territory in every sense of the word. Intentional living not only defines the attitude that will help you work toward improvement, it also defines how you will continue to live going forward.

For every case that takes a definitive route, and a measurable outcome, others can spend a lifetime making even a portion of headway that others may achieve.

When anyone claims to know the way, it’s only because that’s the way that works for them. There’s no other way to say it. Rehabilitation after a TBI (no matter what variety) is always on a case-by-case basis, with progress being made according to many variables and factors.

Cognitive rehabilitation should be left to professional clinicians, and follow-up cognitive growth can be an independent venture – and best if applied in line with your doctor’s overall plan. I’ll be excerpting some information from the book “Brain Injury – It is a Journey” that is an excellent resource for families of TBI survivors that are helping someone they love to begin their journey.

*In the book, there are tons of resources, but one of the most poignant points are in these simple checklists:

Changes After Brain Injury

Changes in a person after a brain injury depend on which areas of the brain are affected and the severity of the injury. Use these lists to check mark affected areas.

These will change over time as the person progresses. Possible consequences of a brain injury includes:

Physical consequences

– Headaches

– Seizures

– Muscle spasticity

– Weakness or paralysis

– Balance and coordination difficulties

– Changes in vision or hearing

– Loss of smell or taste

– Difficulty swallowing

– Changes in appetite

– Increased sensitivity to smells, light or sound

– Changes in sensitivity to touch

– Fatigue, increased need for sleep

– Changes in sleep patterns

 

Cognitive (thinking and learning) consequences

– Amnesia

– Short-term memory loss

– Long-term memory loss

– Slowed ability to process information

– Difficulty organizing and planning ahead

– Poor judgment

– Inability to do more than one thing at a time

– Lack of initiating or starting activities

– Easily distracted

– Disoriented or confused to surroundings

– Shorter attention span

– Repeatedly says or thinks same thing

 

Communication consequences

– Slurred or unclear speech

– Difficulty finding the right word

– Difficulty staying on topic

– Trouble listening

– Dominating conversations

– Difficulty reading

– Rate of speech too fast or too slow

– Things taken too literally

– Difficulty understanding what is said

 

Emotional/Behavioral consequences

– Increased anxiety

– Depression

– Self centered behavior or thinking

– Easily irritated, angered or frustrated

– Overreacts, cries or laughs too easily

– Different sexual behavior

– Impulsive, acts or talks without thinking

– Mood swings

– Stubbornness

– Dependent or clinging behavior*

[…]

more —>  Intentional Living After TBI – Brain Injury Blog With Free TBI Information

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