Posts Tagged Traumatic Brain Injury

[Abstract] Pharmacological Optimization for Successful Traumatic Brain Injury Drug Development

The purpose of this review is to highlight the pharmacological barrier to drug development for traumatic brain injury (TBI) and to discuss best practice strategies to overcome such barriers. Specifically, this article will review the pharmacological considerations of moving from the disease target “hit” to the “lead” compound with drug-like and central nervous system (CNS) penetrant properties. In vitro assessment of drug-like properties will be detailed, followed by pre-clinical studies to ensure adequate pharmacokinetic and pharmacodynamic characteristics of response. The importance of biomarker development and utilization in both pre-clinical and clinical studies will be detailed, along with the importance of identifying diagnostic, pharmacodynamic/response, and prognostic biomarkers of injury type or severity, drug target engagement, and disease progression. This review will detail the important considerations in determining in vivo pre-clinical dose selection, as well as cross-species and human equivalent dose selection. Specific use of allometric scaling, pharmacokinetic and pharmacodynamic criteria, as well as incorporation of biomarker assessments in human dose selection for clinical trial design will also be discussed. The overarching goal of this review is to detail the pharmacological considerations in the drug development process as a method to improve both pre-clinical and clinical study design as we evaluate novel therapies to improve outcomes in patients with TBI.

 

via Pharmacological Optimization for Successful Traumatic Brain Injury Drug Development | Journal of Neurotrauma

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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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[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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[Graphic] BRAIN Injury Awareness

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[ARTICLE] Impact of Traumatic Brain Injury on Neurogenesis – Full Text

New neurons are generated in the hippocampal dentate gyrus from early development through adulthood. Progenitor cells and immature granule cells in the subgranular zone are responsive to changes in their environment; and indeed, a large body of research indicates that neuronal interactions and the dentate gyrus milieu regulates granule cell proliferation, maturation, and integration. Following traumatic brain injury (TBI), these interactions are dramatically altered. In addition to cell losses from injury and neurotransmitter dysfunction, patients often show electroencephalographic evidence of cortical spreading depolarizations and seizure activity after TBI. Furthermore, treatment for TBI often involves interventions that alter hippocampal function such as sedative medications, neuromodulating agents, and anti-epileptic drugs. Here, we review hippocampal changes after TBI and how they impact the coordinated process of granule cell adult neurogenesis. We also discuss clinical TBI treatments that have the potential to alter neurogenesis. A thorough understanding of the impact that TBI has on neurogenesis will ultimately be needed to begin to design novel therapeutics to promote recovery.

Introduction

Adult neurogenesis in the hippocampal dentate gyrus is widespread in mammals. Generation of dentate granule cells occurs late in embryonic development, continues after birth, and persists into old age in most mammals examined (Amrein et al., 2011Amrein, 2015Ngwenya et al., 2015). Studies in rodents indicate that adult generated granule cells play a role in hippocampal dependent learning (Nakashiba et al., 2012Danielson et al., 2016Johnston et al., 2016). Whether neurogenesis continues into old age in humans remains controversial (Danzer, 2018a), with studies finding evidence for (Eriksson et al., 1998Spalding et al., 2013Boldrini et al., 2018) and against ongoing neurogenesis (Sorrells et al., 2018). Yet there is general agreement that dentate neurogenesis occurs in childhood and continues throughout young adulthood in humans, and that newly-generated neurons are poised to contribute to hippocampal function. At a minimum, therefore, traumatic brain injuries (TBIs) occurring during adolescence have the potential to disrupt this important process.

The generation, maturation, and integration of new neurons is critical for hippocampal function. This tightly regulated process, however, is easily disrupted by pathological events, such as TBI. In this review, we discuss the coordinated process of adult neurogenesis in the hippocampal subgranular zone (SGZ) and the impact that TBI and TBI treatments have on this process. An understanding of the regulation and dysregulation of neurogenesis is important for determining whether and how therapeutic interventions targeted at adult neurogenesis are useful for TBI treatment.

Neurogenesis Is a Complex, Tightly-Regulated Process

Adult neurogenesis is characterized by multiple “control” points. The number of daughter cells produced by neural stem cells (NSC) located in the SGZ of the dentate gyrus can be modulated by the rate of cell proliferation and survival, while factors regulating fate specification control whether and how the new cells become neurons and integrate into the hippocampal circuitry (see recent review by Song et al., 2016). These control points can be regulated by signals released into the extracellular milieu by both neuronal and non-neuronal cells (Alenina and Klempin, 2015Egeland et al., 2015), neurotrophic and transcription factors (Faigle and Song, 2013Goncalves et al., 2016), neuroinflammatory mediators (Belarbi and Rosi, 2013), metabolic and hormonal changes (Cavallucci et al., 2016Larson, 2018), and direct synaptic input from both glutamatergic and GABAergic neurons (Chancey et al., 2014Alvarez et al., 2016Song et al., 2016Yeh et al., 2018). For additional information, the readers are referred to the excellent reviews cited for each mechanism, and the schematic in Figure 1. Critically, all of these factors can be disrupted by TBI, creating an environment in which immature granule cells and granule cell progenitors no longer receive the proper cues to guide their development.

Figure 1. Generation and integration of adult-born granule cells is a coordinated process that is impacted by TBI. At each stage of adult neurogenesis, the normal process (blue) has potential to be altered by TBI (orange). (1) Quiescent radial neural stem cells (NSCs) in the subgranular zone (SGZ) can be depleted by frequent activation early in life, such as by TBI-induced seizures, leading to deficiencies with age. (2) TBI and its effects, including spreading depolarizations and seizures, cause an increase in proliferation of progenitor cells. (3) Newly-generated neurons migrate from the SGZ to the granule cell layer (GCL), and after TBI abnormal hilar migration is apparent. (4) Parvalbumin interneurons and (5) mossy hilar neurons are susceptible to cell death after TBI. Reduction in their numbers results in decreased GABAergic and glutamatergic (respectively) input to the newly-generated neurons. Newly-generated neurons show additional signs of aberrant neurogenesis such as abnormal connectivity (6), hyperexcitability (7) and inappropriate integration and dendritic maturity (8) which can be caused by changes in the environmental milieu.

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Continue —>  Frontiers | Impact of Traumatic Brain Injury on Neurogenesis | Neuroscience

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[WEB SITE] Intimate partner violence and traumatic brain injury: An “invisible” public health epidemic

While studying brain injuries in the mid-1990s, I began volunteering in a domestic violence shelter. I noticed that the abuse and problems many women reported were consistent with possibly experiencing concussions. Women reported many acts of violence that could cause trauma to the brain, as well as many post-concussive symptoms. Shockingly, my search for literature on this topic yielded zero results.

When I decided to focus my graduate work on this topic, I was even more shocked by what I learned from women who had experienced intimate partner violence (IPV). Of the 99 women I interviewed, 75% reported at least one traumatic brain injury (TBI) sustained from their partners and about half reported more than one — oftentimes many more than one. Also, as I predicted, the more brain injuries a woman reported, the more poorly she tended to perform on cognitive tasks such as learning and remembering a list of words. Additionally, having more brain injuries was associated with higher levels of psychological distress such as worry, depression, and anxiety.

When I published these results, I was excited about the possibility of bringing much needed awareness and research attention to this topic. Unfortunately, over 20 years later — despite the plethora of concussion-related research in athletics and the military — concussion-related research in the context of intimate partner violence remains scant, representing a barely recognized and highly understudied public health epidemic.

What do we know about intimate partner violence-related traumatic brain injuries?

First, we need to understand that an estimated one in three women experience some type of physical or sexual partner violence in their lifetimes. IPV is not a rare event, and it traverses all socioeconomic boundaries. It is the number one cause of homicide for women and the number one cause of violence to women. For many reasons, including the stigma of being abused, many women hide their IPV — so the chances that we all know personally at least a few people who have sustained IPV are quite high.

Though we lack good epidemiological data on the number of women sustaining brain injuries from their partners, the limited data that we do have suggest that the numbers are in the millions in the US alone. Most of these TBIs are mild and are unacknowledged, untreated, and repetitive. Consequently, many women are at risk for persistent post-concussive syndrome with completely unknown longer-term health risks.

What are the signs and symptoms of IPV-related TBI?

A concussion, by definition, is a traumatic brain injury (TBI). All that is required for someone to sustain a TBI or concussion is an alteration in consciousness after some type of external trauma or force to the brain. For example, either being hit in the head with a hard object (such as a fist), or having a head hit against a hard object (such as a wall or floor), can cause a TBI. If this force results in confusion, memory loss around the event, or loss of consciousness, this is a TBI. Dizziness or seeing stars or spots following such a force can also indicate a TBI. A loss of consciousness is not required, and in fact does not occur in the majority of mild TBIs.

There are often no physical signs that a TBI has occurred. Recognizing that an IPV-related TBI has occurred will typically involve asking the woman about her experience following a blow to the head or violent force to the brain, and then listening for signs of an alteration of consciousness (such as confusion, memory loss, loss of consciousness). Within the next days or week, a range of physical, emotional, behavioral, or cognitive issues may indicate post-concussive symptoms that could include

  • headaches
  • dizziness
  • feeling depressed or tearful
  • being irritable or easily angered
  • frustration
  • restlessness
  • having poor concentration
  • sleep disturbances
  • forgetfulness
  • taking longer to think.

If a TBI is suspected, a woman should see a doctor if possible. Sustaining additional TBIs while still symptomatic will likely increase the time to recovery, and possibly increase the likelihood of more long-term difficulties.

What can we do?

An important component of addressing IPV-related TBI is to raise awareness and destigmatize intimate partner violence. IPV is unfortunately quite common, and some estimates suggest that millions of women may be sustaining unacknowledged, unaddressed, and often repetitive mild TBIs or concussions from their partners. Talking openly and honestly about this problem, especially in cases were abuse may be suspected, is critical. As we open up this conversation about the commonality of IPV with nonjudgmental acceptance of a woman’s experience, we will be in a better place to hear, understand, and support women who may be unknowing members of this invisible public health epidemic.

Resources

If you or someone you know is experiencing intimate partner violence, The Hotline is a 24/7 support service that has a wealth of resources, including access to service providers and shelters across the US.

Follow me on Twitter @EveValera2

 

via Intimate partner violence and traumatic brain injury: An “invisible” public health epidemic – Harvard Health Blog – Harvard Health Publishing

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[Abstract] Cognitive rehabilitation in patients with traumatic brain injury: A narrative review on the emerging use of virtual reality

Highlights

About 10% of TBI patients have a severe brain damage with severe motor and cognitive dysfunctions.

New cognitive interventions, including VR training, can be useful in TBI.

VR creates a positive, motivating and enjoyable learning experience for the TBI patients.

Abstract

Traumatic brain injury (TBI) is a clinical condition characterized by brain damage due to an external, rapid and violent force. TBI causes attention, memory, affectivity, behaviour, planning, and executive dysfunctions, with a significant impact on the quality of life of the patient and of his/her family. Cognitive and motor rehabilitation programs are essential for clinical recovery of TBI patients, improving functional outcomes and the quality of life. Various researches have underlined the possible effectiveness of innovative techniques, with regard to virtual reality (VR), during the different phases of rehabilitation after TBI. This review aims to evaluate the role of VR tools in cognitive assessment and rehabilitation in individuals affected by TBI. Studies performed between 2010 and 2017 and fulfilling the selected criteria were found on PubMed, Scopus, Cochrane and Web of Sciences databases. The search combined the terms VR, assessment, rehabilitation and TBI. Our review has shown that VR has the potential to provide an effective assessment and rehabilitation tool for the treatment of cognitive and behavioral impairment on TBI patients.

via Cognitive rehabilitation in patients with traumatic brain injury: A narrative review on the emerging use of virtual reality – Journal of Clinical Neuroscience

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[ARTICLE] The Involvement of Iron in Traumatic Brain Injury and Neurodegenerative Disease – Full Text

Traumatic brain injury (TBI) consists of acute and long-term pathophysiological sequelae that ultimately lead to cognitive and motor function deficits, with age being a critical risk factor for poorer prognosis. TBI has been recently linked to the development of neurodegenerative diseases later in life including Alzheimer’s disease, Parkinson’s disease, chronic traumatic encephalopathy, and multiple sclerosis. The accumulation of iron in the brain has been documented in a number of neurodegenerative diseases, and also in normal aging, and can contribute to neurotoxicity through a variety of mechanisms including the production of free radicals leading to oxidative stress, excitotoxicity and by promoting inflammatory reactions. A growing body of evidence similarly supports a deleterious role of iron in the pathogenesis of TBI. Iron deposition in the injured brain can occur via hemorrhage/microhemorrhages (heme-bound iron) or independently as labile iron (non-heme bound), which is considered to be more damaging to the brain. This review focusses on the role of iron in potentiating neurodegeneration in TBI, with insight into the intersection with neurodegenerative conditions. An important implication of this work is the potential for therapeutic approaches that target iron to attenuate the neuropathology/phenotype related to TBI and to also reduce the associated risk of developing neurodegenerative disease.

Introduction

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, particularly amongst young adults. Ten million individuals are affected by TBI annually, costing a staggering $9–10 billion/year (Gardner et al., 2017). The aged population have a greater risk of sustaining a TBI, with frequent falls being the major cause of injury, and they also have worse outcomes post-injury compared to other age groups (Stocchetti et al., 2012). Aging is also accompanied by a number of co-morbidities which may contribute to poorer outcomes in these individuals following TBI (Stocchetti et al., 2012). Common secondary events that follow the primary impact are neuronal cell death, oxidative stress, brain oedema, blood-brain barrier (BBB) breakdown, and inflammation (Toklu and Tumer, 2015). TBI often results in debilitating long-term cognitive and motor impairments, and there are currently no approved treatments available for TBI patients (Bramlett and Dietrich, 2015). This highlights the need for therapeutic agents that can alleviate brain damage and the deficits caused by the primary injury and more specifically the reversible secondary pathologies that develop after TBI.

Iron homeostasis appears to be an important process in the pathobiology of TBI. Iron is essential for normal brain functioning where it acts as an essential cofactor for several enzymatic/cellular processes (Ke and Qian, 2007). However, impaired regulation of iron can result in the production of reactive oxygen species (ROS) and the consequent promotion of oxidative stress, which can wreak havoc on an already compromised brain in the context of TBI (Nunez et al., 2012). Interestingly, the accumulation of iron in various tissues and cells in the body and brain is an inevitable consequence of aging (Hagemeier et al., 2012Del et al., 2015). A concomitant increase in the iron storage protein (i.e., ferritin), which can scavenge any excess iron and prevent undesired production of ROS, is also evident with aging (Andersen et al., 2014). However, failed or weakened antioxidant defenses and mitochondrial dysfunction that progresses with aging can disrupt the balance and allow for excessive iron to be released (Venkateshappa et al., 2012a,bAndersen et al., 2014). This can cause pathological iron overload resulting in cellular damage that is considered to be a contributing factor in several degenerative diseases that are more prevalent with age, such as cancer, liver fibrosis, cardiovascular disease, diabetes (type II), and particularly neurological conditions such as Alzheimer’s disease (AD) (Smith et al., 1997Kalinowski and Richardson, 2005Ward et al., 2014Hare et al., 2016). Abnormal brain iron deposition has also been discovered in other neurodegenerative diseases, such as Parkinson’s disease (PD) (Griffiths et al., 1999Zhang et al., 2010Barbosa et al., 2015), multiple sclerosis (MS) (Bergsland et al., 2017), amyotrophic lateral sclerosis (ALS) (Oshiro et al., 2011), Huntington’s disease (Agrawal et al., 2018), and Friedreich’s ataxia (Martelli and Puccio, 2014), and there is now increasing evidence of altered iron levels in TBI patients (Raz et al., 2011Lu et al., 2015). This raises the interesting proposition of an intersection between aging, iron, TBI and neurodegenerative disease. Whilst the role of iron in TBI is not well known, the literature suggests that the levels of iron (and other metals such as zinc) are abnormally regulated following injury, and that the pharmacological targeting (e.g., using chelators or chaperones) of these metals may be beneficial in improving outcomes. Iron chelation therapy has been approved for decades for the treatment of iron overload conditions, and there is a recent heightened interest for their use in neurodegenerative diseases (Kalinowski and Richardson, 2005Dusek et al., 2016). Here, we review the role of iron dyshomeostasis in TBI and gain a deeper understanding of its involvement in neurodegeneration as well as neuroinflammation (Figure 1). We further examine the potential benefit of utilizing iron chelation therapy with the hope of limiting iron-induced neurotoxicity in TBI.

Figure 1. The consequence of iron dyshomeostasis following TBI. TBI results in several secondary events including blood-brain barrier (BBB) breakdown, hemorrhage and iron dyshomeostasis. Together this leads to the accumulation of heme and/or non-heme bound iron in the brain. Iron can participate in Haber-Weiss/Fenton reactions and can promote oxidative stress, neuronal death, inflammation as well as tau phosphorylation/amyloid-β deposition. This contributes to the pathology of TBI, ultimately resulting in neurological decline and an increased risk of developing neurodegenerative disease.

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Continue —>  Frontiers | The Involvement of Iron in Traumatic Brain Injury and Neurodegenerative Disease | Neuroscience

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[WEB SITE] Traumatic Brain Injury Resource Guide – Brain Injury News 12/7/2018 to 01/02/2018

Brain Injury News

Date Title
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
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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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[ARTICLE] Outcome Measures for Persons With Moderate to Severe Traumatic Brain Injury: Recommendations From the American Physical Therapy Association Academy of Neurologic Physical Therapy TBI EDGE Task Force – Full Text

Background and Purpose: The use of standardized outcome measures (OMs) is essential in assessing the effectiveness of physical therapy (PT) interventions. The purposes of this article are (1) to describe the process used by the TBI EDGE task force to assess the psychometrics and clinical utility of OMs used with individuals with moderate to severe traumatic brain injury (TBI); (2) to describe the consensus recommendations for OM use in clinical practice, research, and professional (entry-level) PT education; and (3) to make recommendations for future work.

Methods: An 8-member task force used a modified Delphi process to develop recommendations on the selection of OMs for individuals with TBI. A 4-point rating scale was used to make recommendations based on practice setting and level of ambulation. Recommendations for appropriateness for research use and inclusion in entry-level education were also provided.

Results: The TBI EDGE task force reviewed 88 OMs across the International Classification of Functioning, Disability, and Health (ICF) domains: 15 measured body functions/structure only, 21 measured activity only, 23 measured participation only, and 29 OMs covered more than 1 ICF domain.

Discussion and Conclusions: Recommendations made by the TBI EDGE task force provide clinicians, researchers, and educators with guidance for the selection of OMs. The use of these recommendations may facilitate identification of appropriate OMs in the population with moderate to severe TBI. TBI EDGE task force recommendations can be used by clinicians, researchers, and educators when selecting OMs for their respective needs. Future efforts to update the recommendations are warranted in order to ensure that recommendations remain current and applicable.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A140).

INTRODUCTION

The use of standardized outcome measures (OMs) in physical therapy (PT) practice is growing and becoming the standard of practice. Evidence of intervention effectiveness depends on, among other things, common use of valid and reliable tests and measures, which reflect clinically important outcomes and are responsive to change. An important initial step toward best practice is the identification and selection of the most appropriate OMs for patients whom therapists treat. However, clinicians may be uncertain in how to select the best OM based on an individual’s specific limitations.1,2 Common barriers to using OMs include the time required to learn or use them, perceptions that OMs are too difficult for patients to understand, and the time burden for clinicians to score and analyze test results.3 The ability to track patient progress during recovery from a neurologic condition improves with the use of standardized OMs that are employed across settings. In addition, the use of common OMs may facilitate ongoing clinical research.

To address some of these issues, the Academy of Neurologic Physical Therapy of the American Physical Therapy Association (APTA) began a process to develop recommendations for the identification of core sets of OMs in 2009. A Research Section of APTA task force, the Evaluation Database to Guide Effectiveness (EDGE), was developed to make recommendations for OM utilization in PT practice. Building on recommendations from that group, members of the Academy of Neurologic Physical Therapy initiated what was described as an “EDGE group” focusing on the stroke population. This group established a yearlong process for rating and evaluating OMs, which culminated in the StrokEDGE report.4 The following year, the process was followed by a group focused on OMs for patients with Multiple Sclerosis.5 In the fall of 2011, the Academy of Neurologic Physical Therapy initiated task forces to evaluate OM use in traumatic brain injury (TBI) and spinal cord injury. Task forces looking at vestibular dysfunction and Parkinson disease measures were conducted the following year.

The choice of appropriate OMs for use with TBI can be a challenge. Traumatic brain injury is a chronic health condition that affects physical, cognitive, and behavioral function, often in heterogenous ways. Outcome measures must accommodate a large range of physical and cognitive strengths and limitations. Clinicians must be aware of the complexity of this diagnosis to determine which OMs are most appropriate.6 After TBI, individuals are treated in a wide variety of settings, including intensive care units, acute care, in- and outpatient rehabilitation settings, long-term care facilities, and in the home. The environment, available space and equipment, as well as the individual’s cognitive and physical limitations, all influence which OMs are feasible and appropriate.

The objectives of the TBI EDGE task force were:

  1. to develop recommendations for clinicians, educators, and researchers for the use of standardized OMs to utilize throughout the continuum of care of the TBI population and span the domains of the International Classification of Functioning, Disability, and Health (ICF) and,
  2. following the Academy of Neurologic Physical Therapy Board of Directors approval, to disseminate recommendations through available avenues such as the section Web site, conference presentations, and publications.

The work of each EDGE task force had traditionally been completed in a year period, requiring a scope sufficiently focused to be feasible with a limited volunteer workforce. It is the goal of this article to describe the yearlong processes that were used to create recommendations for OM utilization in the TBI patient population in clinical practice, as well as additional recommendations for inclusion into entry-level PT curricula and for use in research.[…]

 

Continue —> Outcome Measures for Persons With Moderate to Severe Traumat… : Journal of Neurologic Physical Therapy

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