Methodological Issues in Longitudinal Research on Cognitive Recovery after Traumatic Brain Injury: Evidence from a Systematic Review

2013 ◽  
Vol 14 (3) ◽  
pp. 450-474 ◽  
Author(s):  
Regina Schultz ◽  
Robyn L. Tate
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Longitudinal Research ◽  
Effect Sizes ◽  
Methodological Issues ◽  
Post Injury ◽  
Cognitive Recovery ◽  
Cognitive Domains ◽  
Severe Tbi

Background: Previous research addressing cognitive recovery after traumatic brain injury (TBI) in adults has predominately used cross-sectional methods. This systematic review examines longitudinal research into cognitive recovery in the first 2 years following moderate-to-severe TBI in adults and aims to identify apparent methodological issues with the existing literature.Design: Systematic review of the first 2 years post-trauma.Setting: Data were extracted from three electronic databases and manual searches of published articles until October 2012.Participants: Two hundred and forty-two participants with severe TBI and 281 comparison participants were used to calculate effect sizes.Results: Twenty papers met the selection criteria, with effect sizes computed from four studies. Moderate-to-large effect sizes were initially observed between the TBI and comparison groups on most measures (range: d = 0.2–2.8). Recovery continued in all five cognitive domains over the 2 years post-injury.Conclusions: Results demonstrated that cognitive recovery was continuous throughout the first 2 years following moderate-to-severe TBI. Findings also indicated different rates of recovery for the specific cognitive domains, highlighting the heterogeneous nature of cognitive recovery after TBI. The review highlighted several methodological issues within the limited existing literature; recommendations were developed to improve the evidence base.

scholarly journals The scale of neurodegeneration in moderate-to-severe traumatic brain injury: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Bhanu Sharma ◽  
Alana T. Changoor ◽  
Leanne Monteiro ◽  
Brenda Colella ◽  
Robin E. A. Green
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Diffusion Tensor ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Cochrane Central Register ◽  
Post Injury ◽  
Severe Tbi

Abstract Background Our understanding of recovery after moderate-to-severe traumatic brain injury (TBI) has shifted. Until recently, it was presumed that following a period of acute neurological vulnerability, the brain remained stable in the chronic stages of injury. However, recent research has shown neurodegeneration in the chronic stages of moderate-to-severe TBI, challenging the assumption of neurological stability. While there is extensive evidence that neurodegeneration occurs, debate remains regarding the scale and timing. This systematic review will evaluate the scale and timelines of neurodegeneration in adult patients with moderate-to-severe TBI. Methods Literature searches will be conducted in six electronic databases (from inception onwards), including MEDLINE, EMBASE, PsycINFO, CINAHL, SportDiscus, and Cochrane Central Register of Controlled Trials. We will include observational studies that examine neurodegenerative changes within a single sample of TBI patients or studies that compare neuroimaging outcomes between TBI patients and healthy controls. Our primary outcome is structural neuroimaging, and our secondary outcome is diffusion tensor imaging for detection of post-injury white matter changes. All screening, data extraction, and study quality appraisal will be performed independently by the same two study members. It is expected that a narrative summary of the literature will be produced. If feasible, we will conduct a random-effects meta-analysis. However, given the expected heterogeneity between studies (with respect to, for example, timing of imaging, regions imaged) we do not expect to perform a meta-analysis; rather, a narrative synthesis of our findings is expected to be performed. Discussion Understanding the scale and timelines of neurodegeneration in moderate-to-severe TBI (as well as which brain areas are most vulnerable to chronic declines) can inform intervention research designed to offset such changes. This may help improve patient outcome following moderate-to-severe TBI and, in turn, reduce the burden of the injury. Systematic review registration PROSPERO CRD42019117548

Predictors of Emotional Distress in Family Caregivers of Persons with Traumatic Brain Injury: A Systematic Review

2013 ◽  
Vol 14 (1) ◽  
pp. 113-129 ◽  
Author(s):  
Angelle M. Sander ◽  
Kacey Little Maestas ◽  
Allison N. Clark ◽  
Whitney N. Havins
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Family Caregivers ◽  
Emotional Distress ◽  
Future Research ◽  
Class Iii ◽  
Class B ◽  
Assessment And Treatment ◽  
Severe Tbi

The purpose of the current paper was to conduct a systematic review of the literature on predictors of emotional distress in caregivers of persons with traumatic brain injury (TBI), and to provide evidence-based classification for prognostic variables to guide future research and clinical practice. A search was conducted using PubMed, CINAHL and PsycINFO databases. The citations of resulting articles were also reviewed. Twenty-eight articles met inclusion criteria and were retained for review. Reviews were conducted in accordance with the 2011 edition of the American Academy of Neurology (AAN) Guidelines for classifying evidence for prognostic studies. Data abstraction revealed one Class I study, four Class II studies, eight Class III studies, and 15 Class IV studies. Results of the review indicated that caregivers’ report of neurobehavioural problems in the person with injury is a probable predictor of emotional distress for caregivers of persons with complicated mild, moderate or severe TBI (Class B evidence). The level of participation in the person with injury, level of support needed by the person with injury, and family systems functioning are probably predictors of emotional distress for caregivers of persons with severe TBI (Class B evidence). Executive functioning impairment in the person with injury, pre-injury emotional distress in caregivers, caregiver age, caregivers’ use of emotion-focused coping, and social support may possibly be risk factors for caregivers’ emotional distress (Class C evidence). Recommendations for future research and implications for assessment and treatment of family caregivers are discussed.

scholarly journals Serum Neurofilament Light as a Biomarker of Traumatic Brain Injury in the Presence of Concomitant Peripheral Injury

2021 ◽  
Vol 16 ◽  
pp. 117727192110534
Author(s):  
Ker Rui Wong ◽  
William T O’Brien ◽  
Mujun Sun ◽  
Glenn Yamakawa ◽  
Terence J O’Brien ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Elevated Serum ◽  
Serum Levels ◽  
Long Bone ◽  
Post Injury ◽  
Neurofilament Light ◽  
Peripheral Injury ◽  
Long Bone Fracture ◽  
Severe Tbi

Introduction: Serum neurofilament light (NfL) is an emerging biomarker of traumatic brain injury (TBI). However, the effect of peripheral injuries such as long bone fracture and skeletal muscle injury on serum NfL levels is unknown. Therefore, the aim of this study was to determine whether serum NfL levels can be used as a biomarker of TBI in the presence of concomitant peripheral injuries. Methods: Rats were randomly assigned to one of four injury groups: polytrauma (muscle crush + fracture + TBI; n = 11); peripheral injuries (muscle crush + fracture + sham-TBI; n = 12); TBI-only (sham-muscle crush + sham-fracture + TBI; n = 13); and triple-sham (n = 7). At 2-days post-injury, serum levels of NfL were quantified using a Simoa HD-X Analyzer. Results: Compared to triple-sham rats, serum NfL concentrations were higher in rats with peripheral injuries-only, TBI-only, and polytrauma. When compared to peripheral injury-only rats, serum NfL levels were higher in TBI-only and polytrauma rats. No differences were found between TBI-only and polytrauma rats. Conclusion: Serum NfL levels did not differ between TBI-only and polytrauma rats, indicating that significant peripheral injuries did not affect the sensitivity and specificity of serum NfL as a biomarker of moderate TBI. However, the finding of elevated serum NfL levels in rats with peripheral injuries in the absence of a TBI suggests that the presence of such injuries may limit the utility of NfL as a biomarker of less severe TBI (eg, concussion).

White Matter Disruption in Pediatric Traumatic Brain Injury: Results from ENIGMA Pediatric Moderate to Severe Traumatic Brain Injury

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012222
Author(s):  
Emily L Dennis ◽  
Karen Caeyenberghs ◽  
Kristen R Hoskinson ◽  
Tricia L Merkley ◽  
Stacy J Suskauer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Behavioral Problems ◽  
Child Behavior Checklist ◽  
Injury Severity ◽  
Meta Analysis ◽  
Post Injury ◽  
Severe Tbi ◽  
Future Work

Objective:Our study addressed aims: (1) test the hypothesis that moderate-severe TBI in pediatric patients is associated with widespread white matter (WM) disruption; (2) test the hypothesis that age and sex impact WM organization after injury; and (3) examine associations between WM organization and neurobehavioral outcomes.Methods:Data from ten previously enrolled, existing cohorts recruited from local hospitals and clinics were shared with the ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric msTBI working group. We conducted a coordinated analysis of diffusion MRI (dMRI) data using the ENIGMA dMRI processing pipeline.Results:Five hundred and seven children and adolescents (244 with complicated mild to severe TBI [msTBI] and 263 controls) were included. Patients were clustered into three post-injury intervals: acute/subacute - <2 months, post-acute - 2-6 months, chronic - 6+ months. Outcomes were dMRI metrics and post-injury behavioral problems as indexed by the Child Behavior Checklist (CBCL). Our analyses revealed altered WM diffusion metrics across multiple tracts and all post-injury intervals (effect sizes ranging between d=-0.5 to -1.3). Injury severity is a significant contributor to the extent of WM alterations but explained less variance in dMRI measures with increasing time post-injury. We observed a sex-by-group interaction: females with TBI had significantly lower fractional anisotropy in the uncinate fasciculus than controls (𝞫=0.043), which coincided with more parent-reported behavioral problems (𝞫=-0.0027).Conclusions:WM disruption after msTBI is widespread, persistent, and influenced by demographic and clinical variables. Future work will test techniques for harmonizing neurocognitive data, enabling more advanced analyses to identify symptom clusters and clinically-meaningful patient subtypes.

Is Computerized Cognitive Testing Useful in Children and Adolescents with Moderate-to-Severe Traumatic Brain Injury?

2017 ◽  
Vol 23 (4) ◽  
pp. 304-313 ◽  
Author(s):  
Vickie Plourde ◽  
Brian L. Brooks
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Reaction Time ◽  
Cognitive Functioning ◽  
Children And Adolescents ◽  
Severe Traumatic Brain Injury ◽  
Effect Sizes ◽  
Medium Effect ◽  
Control Group ◽  
Severe Tbi

AbstractObjectives: Children and adolescents with moderate-to-severe traumatic brain injury (TBI) present with short and long-term neuropsychological deficits following their injury. The aim of this study was to investigate the utility of a brief computerized test battery for evaluating cognitive functioning sub-acutely following a TBI. Methods: Participants (n=33) sustained a moderate-to-severe TBI, were between 8 and 18 years old, and were assessed using CNS Vital Signs (CNSVS) within 6 months post-injury (median=0.6 month). Participants with TBI were matched to 33 healthy controls based on age, sex, and handedness to compare their cognitive functioning on the CNSVS battery. Results: Children and adolescents with moderate-to-severe TBI had significantly lower scores and large effect sizes on Reaction Time, Complex Attention, and Cognitive Flexibility domains, as well as medium effect sizes on two Visual Memory test scores and one Psychomotor Speed test score. A significantly higher percentage of participants with TBI had cognitive impairment on Reaction Time domain score compared to the control group. Finally, CNSVS domain scores correctly categorized 76% of participants as either group with TBI or control group. Conclusions: CNSVS may be a useful tool for screening cognitive abilities in children and adolescents who are early in their recovery from a moderate-to-severe TBI, particularly when a rapid screening evaluation can help guide management, interventions, and track recovery. (JINS, 2017, 23, 304–313)

scholarly journals Systematic review and meta-analysis of preclinical studies testing mesenchymal stromal cells for traumatic brain injury

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Francesca Pischiutta ◽  
Enrico Caruso ◽  
Alessandra Lugo ◽  
Helena Cavaleiro ◽  
Nino Stocchetti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mesenchymal Stromal Cells ◽  
Effect Size ◽  
Stromal Cells ◽  
Meta Analysis ◽  
Similar Efficacy ◽  
Post Injury ◽  
Neurological Improvement

AbstractMesenchymal stromal cells (MSCs) are widely used in preclinical models of traumatic brain injury (TBI). Results are promising in terms of neurological improvement but are hampered by wide variability in treatment responses. We made a systematic review and meta-analysis: (1) to assess the quality of evidence for MSC treatment in TBI rodent models; (2) to determine the effect size of MSCs on sensorimotor function, cognitive function, and anatomical damage; (3) to identify MSC-related and protocol-related variables associated with greater efficacy; (4) to understand whether MSC manipulations boost therapeutic efficacy. The meta-analysis included 80 studies. After TBI, MSCs improved sensorimotor and cognitive deficits and reduced anatomical damage. Stratified meta-analysis on sensorimotor outcome showed similar efficacy for different MSC sources and for syngeneic or xenogenic transplants. Efficacy was greater when MSCs were delivered in the first-week post-injury, and when implanted directly into the lesion cavity. The greatest effect size was for cells embedded in matrices or for MSC-derivatives. MSC therapy is effective in preclinical TBI models, improving sensorimotor, cognitive, and anatomical outcomes, with large effect sizes. These findings support clinical studies in TBI.

scholarly journals Effect of integrative nursing practices on cognitive recovery among severe traumatic brain injury patients

2020 ◽  
Vol 10 (10) ◽  
pp. 75
Author(s):  
Sahar Younes Othman ◽  
Alaa Mostafa Mohamed ◽  
Azza Hamdi El-Soussi ◽  
Sherif Ahmed Abd El-Monaem ◽  
Fatma Refaat Ahmed
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Function ◽  
Severe Traumatic Brain Injury ◽  
Study Group ◽  
Cognitive Recovery ◽  
Sensory Recovery ◽  
Severe Tbi ◽  
Four Score ◽  
Recovery Assessment

Background and objective: Cognitive recovery after severe traumatic brain injury (TBI) is the biggest challenge facing the critical care nurses (CCNs). Several studies have been reported that the majority of CCNs are concerned with providing conventional nursing practices to severe TBI patients. These practices are directed to stabilize patients’ status rather than to enhance cognitive recovery after TBI. Application of integrative nursing practices for TBI patients can help in enhancing cognitive recovery. Aim: This study aimed to determine the effect of integrative nursing practices on cognitive recovery among severe traumatic brain injury patients.Methods: A quasi experimental research design was utilized. A convenience sample was conducted on 60 adult patients suffering from severe TBI who admitted to the intensive care units of Alexandria Main University Hospital. Patients were assigned into study group (30 patients) and control group (30 patients). One tool was used for data collection namely “Cognitive Recovery Assessment Tool”. This tool was used to assess recovery of cognitive function domains. It consists of level of consciousness using Full Outline of Un-Responsiveness (FOUR) score, level of cognitive functioning using Rancho Los Amigos (RLA) scale and basic cognitive sensory recovery assessment using Western Neuro Sensory Stimulation Profile (WNSSP) scale.Results: The implementation of integrative nursing practices for the study group was associated with statistically significant positive effects. Patients in the study group showed higher means of consciousness revealed by FOUR score and cognitive function revealed by RLA scale. The basic cognitive sensory recovery revealed by WNSSP scale in the study group was also significantly improved.Conclusions: Implementation of integrative nursing practices has been shown to enhance cognitive recovery among severe TBI patients. Thus, it is recommended for use in a nurse’s daily routine of care for severe TBI patients.

The role of amantadine in cognitive recovery early after traumatic brain injury: A systematic review

2020 ◽  
Vol 194 ◽  
pp. 105815 ◽  
Author(s):  
Andrea Loggini ◽  
Ruth Tangonan ◽  
Faten El Ammar ◽  
Ali Mansour ◽  
Fernando D. Goldenberg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Recovery

scholarly journals Cognitive development after traumatic brain injury in young children

2009 ◽  
Vol 16 (1) ◽  
pp. 157-168 ◽  
Author(s):  
AIMEE GERRARD-MORRIS ◽  
H. GERRY TAYLOR ◽  
KEITH OWEN YEATES ◽  
NICOLAY CHERTKOFF WALZ ◽  
TERRY STANCIN ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Development ◽  
Young Children ◽  
Family Environment ◽  
Cognitive Skills ◽  
Visual Memory ◽  
Cognitive Outcomes ◽  
Post Injury ◽  
Severe Tbi

AbstractThe primary aims of this study were to examine post-injury cognitive development in young children with traumatic brain injury (TBI) and to investigate the role of the proximal family environment in predicting cognitive outcomes. Age at injury was 3–6 years, and TBI was classified as severe (n = 23), moderate (n = 21), and complicated mild (n = 43). A comparison group of children who sustained orthopedic injuries (OI, n = 117) was also recruited. Child cognitive assessments were administered at a post-acute baseline evaluation and repeated at 6, 12, and 18 months post-injury. Assessment of the family environment consisted of baseline measures of learning support and stimulation in the home and of parenting characteristics observed during videotaped parent–child interactions. Relative to the OI group, children with severe TBI group had generalized cognitive deficiencies and those with less severe TBI had weaknesses in visual memory and executive function. Although deficits persisted or emerged across follow-up, more optimal family environments were associated with higher scores for all injury groups. The findings confirm other reports of poor recovery of cognitive skills following early childhood TBI and suggest environmental influences on outcomes. (JINS, 2010,16, 157–168.)

scholarly journals Intracranial Pressure Monitors in Traumatic Brain Injury: A Systematic Review

2012 ◽  
Vol 39 (5) ◽  
pp. 571-576 ◽  
Author(s):  
Asher A. Mendelson ◽  
Chris Gillis ◽  
William R. Henderson ◽  
Juan J. Ronco ◽  
Vinay Dhingra ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Observational Studies ◽  
Pooled Analysis ◽  
Point Estimate ◽  
Icp Monitoring ◽  
Study Heterogeneity ◽  
Severe Tbi

We conducted a systematic review to examine the relationship between intracranial pressure monitors (ICP) monitors and mortality in traumatic brain injury (TBI). We systematically searched for articles that met the following criteria: (1) adults patients, (2) TBI, (3) use of an ICP monitor, (4) point estimate for mortality with ICP monitoring (5) adjustment for potential confounders. Six observational studies were identified with 11,371 patients. There was marked between-study heterogeneity that precluded a pooled analysis. Patients with ICP monitors had different clinical characteristics and received more ICP targeted therapy in the ICU. Four studies found no significant relationship between ICP monitoring and survival, while the other two studies demonstrated conflicting results. Significant confounding by indication in observational studies limits the examination of isolated TBI interventions. More research should focus on interventions that affect TBI careplan systems. Further research is needed to identify which subset of severe TBI patients may benefit from ICP monitoring.

Sign in / Sign up

Export Citation Format

Share Document