Measurement and prediction of subjective fatigue following traumatic brain injury

2005 ◽  
Vol 11 (4) ◽  
pp. 416-425 ◽  
Author(s):  
CARLO ZIINO ◽  
JENNIE PONSFORD
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Post Injury ◽  
Related Factors ◽  
Significant Group ◽  
Subjective Fatigue ◽  
Education Levels ◽  
Fatigue Severity ◽  
Gcs Score

Numerous outcome studies have found fatigue to be a common problem following traumatic brain injury (TBI). This study examined the magnitude, causes and impact of fatigue following TBI using three subjective fatigue scales, and investigated its relationship with demographic and injury-related factors, and mood. Forty-nine controls and 49 TBI participants (36.2% with GCS score of 13–15, 29.8% with GCS score of 9–12, and 34% with GCS score of 3–8) were seen at a mean of approximately 8 months post injury. All participants completed three subjective fatigue measures, including the Fatigue Severity Scale (FSS), Visual Analogue Scale–Fatigue (VAS–F) and Causes of Fatigue Questionnaire (COF). TBI participants reported a significantly greater impact of fatigue on their lifestyle on the FSS relative to controls, and reported activities requiring physical and mental effort as more frequent causes of fatigue on the COF. There were, however, no significant group differences on subscales of the VAS–F. Greater time since injury and higher education levels were associated with higher fatigue levels, independent of the effects of mood. Injury severity and age were not found to be significant predictors of subjective fatigue severity in TBI participants. (JINS, 2005,11, 416–425.)

Fatigue and Attention Following Traumatic Brain Injury

2003 ◽  
Vol 14 (3) ◽  
pp. 155-163 ◽  
Author(s):  
Jennie Ponsford ◽  
Carlo Ziino
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Depression And Anxiety ◽  
Severity Scale ◽  
Post Injury ◽  
Related Factors ◽  
High Fatigue ◽  
Fatigue Severity ◽  
Relationship Of ◽  
The Relationship

Abstract: Numerous outcome studies have indicated that fatigue is one of the most universal and persistent problems reported following traumatic brain injury (TBI). The present study will examine fatigue following TBI, as reported subjectively, its relationship with demographic and injury-related factors, depression and anxiety, as well as its relationship with measures of attention and mental speed. In a group of 28 TBI participants and 28 controls, TBI participants reported significantly greater fatigue on the Fatigue Severity Scale. Fatigue was greater in those who were older, more educated and a longer time post-injury. Depression was also associated with high fatigue, but not in all cases. The relationship of subjective fatigue with mental speed and attention will be the next focus of this study.

scholarly journals Moderate and severe traumatic brain injury: effect of blood alcohol concentration on Glasgow Coma Scale score and relation to computed tomography findings

2015 ◽  
Vol 122 (1) ◽  
pp. 211-218 ◽  
Author(s):  
Nils Petter Rundhaug ◽  
Kent Gøran Moen ◽  
Toril Skandsen ◽  
Kari Schirmer-Mikalsen ◽  
Stine B. Lund ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Injury Severity ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Dependent Manner ◽  
Blood Alcohol ◽  
Severe Tbi ◽  
Gcs Score ◽  
Dose Dependent

OBJECT The influence of alcohol is assumed to reduce consciousness in patients with traumatic brain injury (TBI), but research findings are divergent. The aim of this investigation was to study the effects of different levels of blood alcohol concentration (BAC) on the Glasgow Coma Scale (GCS) scores in patients with moderate and severe TBI and to relate the findings to brain injury severity based on the admission CT scan. METHODS In this cohort study, 265 patients (age range 16–70 years) who were admitted to St. Olavs University Hospital with moderate and severe TBI during a 7-year period were prospectively registered. Of these, 217 patients (82%) had measured BAC. Effects of 4 BAC groups on GCS score were examined with ordinal logistic regression analyses, and the GCS scores were inverted to give an OR > 1. The Rotterdam CT score based on admission CT scan was used to adjust for brain injury severity (best score 1 and worst score 6) by stratifying patients into 2 brain injury severity groups (Rotterdam CT scores of 1–3 and 4–6). RESULTS Of all patients with measured BAC, 91% had intracranial CT findings and 43% had BAC > 0 mg/dl. The median GCS score was lower in the alcohol-positive patients (6.5, interquartile range [IQR] 4–10) than in the alcohol-negative patients (9, IQR 6–13; p < 0.01). No significant differences were found between alcohol-positive and alcohol-negative patients regarding other injury severity variables. Increasing BAC was a significant predictor of lower GCS score in a dose-dependent manner in age-adjusted analyses, with OR 2.7 (range 1.4–5.0) and 3.2 (range 1.5–6.9) for the 2 highest BAC groups (p < 0.01). Subgroup analyses showed an increasing effect of BAC group on GCS scores in patients with Rotterdam CT scores of 1–3: OR 3.1 (range 1.4–6.6) and 6.7 (range 2.7–16.7) for the 2 highest BAC groups (p < 0.01). No such relationship was found in patients with Rotterdam CT scores of 4–6 (p = 0.14–0.75). CONCLUSIONS Influence of alcohol significantly reduced the GCS score in a dose-dependent manner in patients with moderate and severe TBI and with Rotterdam CT scores of 1–3. In patients with Rotterdam CT scores of 4–6, and therefore more CT findings indicating increased intracranial pressure, the brain injury itself seemed to overrun the depressing effect of the alcohol on the CNS. This finding is in agreement with the assumption of many clinicians in the emergency situation.

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.

scholarly journals An experimental study of the effect on activity intentions of postconcussion recovery advice

2019 ◽  
Vol 3 ◽  
pp. 205970021987267
Author(s):  
Karen A Sullivan ◽  
Leanne Billing
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Time Frame ◽  
Activity Levels ◽  
Activity Type ◽  
Post Injury ◽  
Significant Group ◽  
Cognitive Rest ◽  
Activity Types

This study tested the effect of issuing return-to-activity advice on activity intentions at Day 2 and Day 10 days post simulated mild traumatic brain injury. One hundred and twenty-eight volunteers were randomly allocated to one of two groups who received ( n =  65) or did not receive standardized post-injury advice ( n =  63). To prime the simulation, the participants read a mild traumatic brain injury vignette about a person who is concussed while playing sport. Then the participants role-played the injured person and reported activity intentions for three activity types (cognitive, physical and restful) twice, once for each time frame (i.e. Day 2 and Day 10). The advice was to rest for the first 24–48 h and then gradually resume normal activities. There was no significant group by activity-type interaction ( p > .05) at Day 2. When both time frames were considered, there was no significant group × time frame interaction for any activity type or any item, except for an increase in non-manual (clerical) work and weight training at Day 10 compared to Day 2 in the group with the advice. In general, the intentions for all activity types were consistent with the recovery advice (i.e., rest then increasing activity), even when the advice was not given. However, at Day 10, cognitive and physical activity levels were still expected to be lower than usual (pre-injury), and many participants were uncertain about the concept of cognitive rest. These factors, along with individual patient circumstances, should be taken into account in rehabilitation planning.

scholarly journals Early Predictors of Employment Status One Year Post Injury in Individuals with Traumatic Brain Injury in Europe

2020 ◽  
Vol 9 (6) ◽  
pp. 2007
Author(s):  
Juan Arango-Lasprilla ◽  
Marina Zeldovich ◽  
Laiene Olabarrieta-Landa ◽  
Marit Forslund ◽  
Silvia Núñez-Fernández ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Employment Status ◽  
Injury Severity ◽  
European Countries ◽  
Post Injury ◽  
Early Predictors ◽  
One Year ◽  
Prospective Longitudinal ◽  
Psychiatric Problems

Sustaining a traumatic brain injury (TBI) often affects the individual’s ability to work, reducing employment rates post-injury across all severities of TBI. The objective of this multi-country study was to assess the most relevant early predictors of employment status in individuals after TBI at one-year post-injury in European countries. Using a prospective longitudinal non-randomized observational cohort (The Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project), data was collected between December 2014–2019 from 63 trauma centers in 18 European countries. The 1015 individuals who took part in this study were potential labor market participants, admitted to a hospital and enrolled within 24 h of injury with a clinical TBI diagnosis and indication for a computed tomography (CT) scan, and followed up at one year. Results from a binomial logistic regression showed that older age, status of part-time employment or unemployment at time of injury, premorbid psychiatric problems, and higher injury severity (as measured with higher Injury severity score (ISS), lower Glasgow Coma Scale (GCS), and longer length of stay (LOS) in hospital) were associated with higher unemployment probability at one-year after injury. The study strengthens evidence for age, employment at time of injury, premorbid psychiatric problems, ISS, GCS, and LOS as important predictors for employment status one-year post-TBI across Europe.

scholarly journals A-125 An Analysis of the Traumatic Brain Injury Outcomes and Needs of People in Urban, Rural and Remote Areas

2020 ◽  
Vol 35 (6) ◽  
pp. 918-918
Author(s):  
Sullivan K ◽  
Hennessy M
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Rural Communities ◽  
Injury Severity ◽  
Community Integration ◽  
Rural And Remote ◽  
Post Injury ◽  
Patient Reported ◽  
Rural And Remote Areas ◽  
Urban Rural

Abstract Objective Little is known about the traumatic brain injury (TBI) outcomes for people returning to urban versus rural communities. These communities typically differ in terms of the availability of formal and informal supports. We compared patient-reported TBI outcomes for three communities (urban, rural, and remote) and modelled their predictors. Method Six hundred and sixty-two cases with mild-to-severe TBI were identified from hospital records. These individuals received a mail-out survey comprised of standardized outcome measures. The measures assessed: symptoms, quality-of-life, service obstacles, unmet needs, mental health, and community integration. Ninety-one people who were less than two years post-injury returned a usable survey (18% response rate). The location of communities was coded using the Accessibility Remoteness Index of Australia (urban n = 22, rural n = 43, remote n = 26). Results There were no differences in the outcomes due to location (p’s &gt; .05). The significant individual predictors of five of the six outcomes were the participant’s sex, age, and the injury severity; but location did not play a role. TBI outcomes were typically worse if the injury was severe, or if the injured person was older or female. For one outcome (community integration) males fared worse than females. Conclusion Contrary to expectations, location did not affect patient-reported TBI outcomes. This could indicate that the same supports are available to patients, despite their location or; that the different supports were relied on to achieve the same outcomes. The overall findings urge continued investment in TBI rehabilitation, particularly for the subgroups that experienced the worst outcomes.

scholarly journals Predicting Behavioral Deficits in Pediatric Traumatic Brain Injury Through Uncinate Fasciculus Integrity

2011 ◽  
Vol 17 (4) ◽  
pp. 663-673 ◽  
Author(s):  
Chad P. Johnson ◽  
Jenifer Juranek ◽  
Larry A. Kramer ◽  
Mary R. Prasad ◽  
Paul R. Swank ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Behavioral Problems ◽  
Injury Severity ◽  
Diffusion Tensor ◽  
Uncinate Fasciculus ◽  
Post Injury ◽  
Orthopedic Injury ◽  
Behavioral Dysregulation ◽  
The Relationship

AbstractBehavioral dysregulation is a common and detrimental consequence of traumatic brain injury (TBI) in children that contributes to poor academic achievement and deficits in social development. Unfortunately, behavioral dysregulation is difficult to predict from either injury severity or early neuropsychological evaluation. The uncinate fasciculus (UF) connects orbitofrontal and anterior temporal lobes, which are commonly implicated in emotional and behavioral regulation. Using probabilistic diffusion tensor tractography (DTT), we examined the relationship between the integrity of the UF 3 months post-injury and ratings of executive functions 12 months post-injury in children with moderate to severe TBI and a comparison group with orthopedic injuries. As expected, fractional anisotropy of the UF was lower in the TBI group relative to the orthopedic injury group. DTT metrics from the UF served as a biomarker and predicted ratings of emotional and behavior regulation, but not metacognition. In contrast, the Glasgow Coma Scale score was not related to either UF integrity or to executive function outcomes. Neuroanatomical biomarkers like the uncinate fasciculus may allow for early identification of behavioral problems and allow for investigation into the relationship of frontotemporal networks to brain-behavior relationships. (JINS, 2011, 17, 663–673)

scholarly journals Social Behavior and Impairments in Social Cognition Following Traumatic Brain Injury

2017 ◽  
Vol 23 (5) ◽  
pp. 400-411 ◽  
Author(s):  
Michelle May ◽  
Maarten Milders ◽  
Bruce Downey ◽  
Maggie Whyte ◽  
Vanessa Higgins ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Social Behavior ◽  
Emotion Recognition ◽  
Social Functioning ◽  
Injury Severity ◽  
Comparison Group ◽  
Response Selection ◽  
Community Integration ◽  
Post Injury

AbstractObjectives:The negative effect of changes in social behavior following traumatic brain injury (TBI) are known, but much less is known about the neuropsychological impairments that may underlie and predict these changes. The current study investigated possible associations between post-injury behavior and neuropsychological competencies of emotion recognition, understanding intentions, and response selection, that have been proposed as important for social functioning.Methods:Forty participants with TBI and 32 matched healthy participants completed a battery of tests assessing the three functions of interest. In addition, self- and proxy reports of pre- and post-injury behavior, mood, and community integration were collected.Results:The TBI group performed significantly poorer than the comparison group on all tasks of emotion recognition, understanding intention, and on one task of response selection. Ratings of current behavior suggested significant changes in the TBI group relative to before the injury and showed significantly poorer community integration and interpersonal behavior than the comparison group. Of the three functions considered, emotion recognition was associated with both post-injury behavior and community integration and this association could not be fully explained by injury severity, time since injury, or education.Conclusions:The current study confirmed earlier findings of associations between emotion recognition and post-TBI behavior, providing partial evidence for models proposing emotion recognition as one of the pre-requisites for adequate social functioning. (JINS, 2017,23, 400–411)

scholarly journals Longitudinal Analyses of the Reciprocity of Depression and Anxiety after Traumatic Brain Injury and Its Clinical Implications

2021 ◽  
Vol 10 (23) ◽  
pp. 5597
Author(s):  
Biyao Wang ◽  
Marina Zeldovich ◽  
Katrin Rauen ◽  
Yi-Jhen Wu ◽  
Amra Covic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
First Year ◽  
Depression And Anxiety ◽  
Post Injury ◽  
Related Factors ◽  
Cross Domain ◽  
Psychiatric Disturbances ◽  
Patient Reported

Depression and anxiety are common following traumatic brain injury (TBI). Understanding their prevalence and interplay within the first year after TBI with differing severities may improve patients’ outcomes after TBI. Individuals with a clinical diagnosis of TBI recruited for the large European collaborative longitudinal study CENTER-TBI were screened for patient-reported major depression (MD) and generalized anxiety disorder (GAD) at three, six, and twelve months post-injury (N = 1683). Data were analyzed using autoregressive cross-lagged models. Sociodemographic, premorbid and injury-related factors were examined as risk factors. 14.1–15.5% of TBI patients reported moderate to severe MD at three to twelve months after TBI, 7.9–9.5% reported GAD. Depression and anxiety after TBI presented high within-domain persistency and cross-domain concurrent associations. MD at three months post-TBI had a significant impact on GAD at six months post-TBI, while both acted bidirectionally at six to twelve months post-TBI. Being more severely disabled, having experienced major extracranial injuries, an intensive care unit stay, and being female were risk factors for more severe MD and GAD. Major trauma and the level of consciousness after TBI were additionally associated with more severe MD, whereas being younger was related to more severe GAD. Individuals after TBI should be screened and treated for MD and GAD early on, as both psychiatric disturbances are highly persistent and bi-directional in their impact. More severely disabled patients are particularly vulnerable, and thus warrant timely screening and intensive follow-up treatment.

scholarly journals Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study

2020 ◽  
Vol 34 (9) ◽  
pp. 814-830
Author(s):  
Louis Jacob ◽  
Mélanie Cogné ◽  
Olli Tenovuo ◽  
Cecilie Røe ◽  
Nada Andelic ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multicenter Study ◽  
Western Europe ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Significant Proportion ◽  
Sociodemographic Factors ◽  
Related Factors ◽  
Direct Discharge

Background Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. Objective Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. Methods Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. Results In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). Conclusions Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.

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