Executive Functions and Their Relation to Sleep Following Mild Traumatic Brain Injury in Preschoolers

AbstractObjectives:Traumatic brain injury (TBI) sustained during childhood is known to impact children’s executive functioning. However, few studies have focused specifically on executive functioning after preschool TBI. TBI has also been associated with sleep disturbances, which are known to impair executive functions in healthy children. The aim of this study was to investigate executive functions in preschoolers with mild TBI, and to determine the role of sleep in the links between TBI and executive functioning.Methods:The sample was drawn from a longitudinal study and included 167 children, aged 18 to 60 months, divided into 2 groups: children with accidental mild TBI (n=84) and typically developing children (n=83). Children were assessed 6 months post-injury on executive function measures (inhibition and cognitive flexibility) and sleep measures (actigraphy data and parental rating of sleep problems).Results:The two groups did not differ in their executive abilities. However, relative to controls, children with mild TBI and shorter nighttime sleep duration or increased sleep problems exhibited poorer executive functions.Conclusions:These results support a “double hazard” effect, whereby the combination of sleep disturbances and mild TBI results in poorer executive functions. The findings highlight the importance of assessing and monitoring the quality of sleep even after mild head injuries. Poor sleep may place children at risk for increased cognitive difficulties. (JINS, 2018,24, 769–780)

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Do sleep difficulties exacerbate deficits in sustained attention following traumatic brain injury?

Journal of the International Neuropsychological Society ◽

10.1017/s1355617709990798 ◽

2009 ◽

Vol 16 (1) ◽

pp. 17-25 ◽

Cited By ~ 52

Author(s):

IMOGEN L.M. BLOOMFIELD ◽

COLIN A. ESPIE ◽

JONATHAN J. EVANS

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Sustained Attention ◽

Sleep Disturbances ◽

Sleep Problems ◽

Poor Sleep ◽

Injury Rehabilitation ◽

Attentional Functioning ◽

Sleep Difficulties ◽

Good Sleep

AbstractSustained attention has been shown to be vulnerable following traumatic brain injury (TBI). Sleep restriction and disturbances have been shown to negatively affect sustained attention. Sleep disorders are common but under-diagnosed after TBI. Thus, it seems possible that sleep disturbances may exacerbate neuropsychological deficits for a proportion of individuals who have sustained a TBI. The aim of this prospective study was to examine whether poor sleepers post-TBI had poorer sustained and general attentional functioning than good sleepers post-TBI. Retrospective subjective, prospective subjective, and objective measures were used to assess participants’ sleep. The results showed that the poor sleep group had significantly poorer sustained attention ability than the good sleep group. The differences on other measures of attention were not significant. This study supports the use of measures that capture specific components of attention rather than global measures of attention, and highlights the importance of assessing and treating sleep problems in brain injury rehabilitation. (JINS, 2010, 16, 17–25.)

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A-126 Clinical Utility of Risk Factors to Predict Self-reported Neurobehavioral Outcome Following Traumatic Brain Injury: PTSD, Sleep, Resilience, and Lifetime Blast Exposure

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.126 ◽

2020 ◽

Vol 35 (6) ◽

pp. 919-919

Author(s):

Lange R ◽

Lippa S ◽

Hungerford L ◽

Bailie J ◽

French L ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Risk Factor ◽

Brain Injury ◽

Clinical Utility ◽

Poor Sleep ◽

Post Injury ◽

Poor Outcome ◽

Blast Exposure ◽

Neurobehavioral Outcome

Abstract Objective To examine the clinical utility of PTSD, Sleep, Resilience, and Lifetime Blast Exposure as ‘Risk Factors’ for predicting poor neurobehavioral outcome following traumatic brain injury (TBI). Methods Participants were 993 service members/veterans evaluated following an uncomplicated mild TBI (MTBI), moderate–severe TBI (ModSevTBI), or injury without TBI (Injured Controls; IC); divided into three cohorts: (1) < 12 months post-injury, n = 237 [107 MTBI, 71 ModSevTBI, 59 IC]; (2) 3-years post-injury, n = 370 [162 MTBI, 80 ModSevTBI, 128 IC]; and (3) 10-years post-injury, n = 386 [182 MTBI, 85 ModSevTBI, 119 IC]. Participants completed a 2-hour neurobehavioral test battery. Odds Ratios (OR) were calculated to determine whether the ‘Risk Factors’ could predict ‘Poor Outcome’ in each cohort separately. Sixteen Risk Factors were examined using all possible combinations of the four risk factor variables. Poor Outcome was defined as three or more low scores (< 1SD) on five TBI-QOL scales (e.g., Fatigue, Depression). Results In all cohorts, the vast majority of risk factor combinations resulted in ORs that were ‘clinically meaningful’ (ORs > 3.00; range = 3.15 to 32.63, all p’s < .001). Risk factor combinations with the highest ORs in each cohort were PTSD (Cohort 1 & 2, ORs = 17.76 and 25.31), PTSD+Sleep (Cohort 1 & 2, ORs = 18.44 and 21.18), PTSD+Sleep+Resilience (Cohort 1, 2, & 3, ORs = 13.56, 14.04, and 20.08), Resilience (Cohort 3, OR = 32.63), and PTSD+Resilience (Cohort 3, OR = 24.74). Conclusions Singularly, or in combination, PTSD, Poor Sleep, and Low Resilience were strong predictors of poor outcome following TBI of all severities and injury without TBI. These variables may be valuable risk factors for targeted early interventions following injury.

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Coping Strategies as a Predictor of Post-concussive Symptoms in Children with Mild Traumatic Brain Injury versus Mild Orthopedic Injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617710001700 ◽

2011 ◽

Vol 17 (2) ◽

pp. 317-326 ◽

Cited By ~ 34

Author(s):

Stacey E. Woodrome ◽

Keith Owen Yeates ◽

H. Gerry Taylor ◽

Jerome Rusin ◽

Barbara Bangert ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Coping Strategies ◽

Mild Traumatic Brain Injury ◽

Group Differences ◽

Post Injury ◽

Mild Tbi ◽

Orthopedic Injury ◽

Children's Coping ◽

Over Time

AbstractThis study examined whether children's coping strategies are related to post-concussive symptoms following mild traumatic brain injury (TBI) versus orthopedic injury (OI). Participants were 8- to 15-year-old children with mild TBI (n = 167) or OI (n = 84). They rated their current preferred coping strategies and post-injury symptoms at 2 weeks (baseline) and 1, 3, and 12 months post-injury. Children's reported use of coping strategies did not vary significantly over time, so their baseline coping ratings were examined as predictors of post-concussive symptoms across time. Self-ratings of symptoms were positively related to emotion-focused strategies and negatively related to problem-focused engagement after both mild TBI and OI. Higher problem-focused disengagement predicted larger group differences in children's ratings of symptoms, suggesting that problem-focused disengagement moderates the effects of mild TBI. Coping strategies collectively accounted for approximately 10–15% of the variance in children's post-concussive symptoms over time. The findings suggest that coping may play an important role in accounting for children's perceptions of post-concussive symptoms after mild TBI. (JINS, 2011, 17, 317–326)

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Executive Function Training in Chronic Traumatic Brain Injury Patients: Study Protocol

10.21203/rs.2.273/v1 ◽

2019 ◽

Author(s):

Daniel Krawczyk ◽

Kihwan Han ◽

David Martinez ◽

Jelena Rakic ◽

Matthew Kmiecik ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Working Memory ◽

Executive Function ◽

Brain Injury ◽

Executive Functions ◽

Inhibitory Control ◽

Cognitive Rehabilitation ◽

Daily Life ◽

Chronic Phase ◽

Post Injury

Abstract Background: Some individuals who sustain traumatic brain injuries (TBIs) continue to experience significant cognitive impairments chronically (months-to-years post-injury). Many tests of executive function are insensitive to these executive function impairments, as such impairments may only appear during complex daily life conditions. Daily life often requires us to divide our attention and focus on abstract goals. In the current study, we compare the effects of two one-month electronic cognitive rehabilitation programs for individuals with chronic TBI. The active program (Expedition: Strategic Advantage) focuses on improving goal-directed executive functions including working memory, planning, long-term memory, and inhibitory control by challenging participants to accomplish life-like cognitive simulations. The challenge level of the simulations increase in accordance with participant achievement. The control intervention (Expedition: Informational Advantage) is identical to the active; however, the cognitive demand level is capped preventing participants from advancing beyond a set level. We will evaluate these interventions with a military veteran TBI population. Methods: One hundred individuals will be enrolled in this double-blinded clinical trial (all participants and testers are blinded to condition). Each individual will be randomly assigned to one of two interventions. The primary anticipated outcomes are improvement of daily life cognitive function skills and daily life functions. These are measured by a daily life performance task, which tests cognitive skills, and a survey that evaluates daily life functions. Secondary outcomes are also predicted to include improvements in working memory, attention, planning, and inhibitory control as measured by a neuropsychological test battery. Lastly, neuroimaging measures will be used to evaluate changes in brain networks supporting cognition pre-intervention and post-intervention. Discussion: We will test whether electronically delivered cognitive rehabilitation aimed at improving daily life functional skills will provide cognitive and daily life functional improvements for individuals in the chronic phase of TBI recovery (greater than three months post-injury). We aim to better understand the cognitive processes involved in recovery and the characteristics of individuals most likely to benefit. This study will also address the potential to observe generalizability, or transfer, from a software-based cognitive training tool toward daily life improvement. Trial Registration: ClinicalTrials.gov Identifier: NCT03704116 (retrospectively registered) https://clinicaltrials.gov/ct2/show/NCT03704116?term=tbi+krawczyk&rank=1 Keywords: Cognitive rehabilitation, traumatic brain injury, executive functions, daily life functions, memory, attention, planning. Support: Joint Warfighter Program; U. S. Dept. of Defense W81XWH-16-1-0053

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A Preliminary DTI Tractography Study of Developmental Neuroplasticity 5–15 Years After Early Childhood Traumatic Brain Injury

Frontiers in Neurology ◽

10.3389/fneur.2021.734055 ◽

2021 ◽

Vol 12 ◽

Author(s):

Elisabeth A. Wilde ◽

Ilirjana Hyseni ◽

Hannah M. Lindsey ◽

Jessica Faber ◽

James M. McHenry ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Early Childhood ◽

Brain Injury ◽

Executive Functioning ◽

Verbal Memory ◽

Developmental Plasticity ◽

Right Hemisphere ◽

Post Injury ◽

Perforant Pathway ◽

Dti Tractography

Plasticity is often implicated as a reparative mechanism when addressing structural and functional brain development in young children following traumatic brain injury (TBI); however, conventional imaging methods may not capture the complexities of post-trauma development. The present study examined the cingulum bundles and perforant pathways using diffusion tensor imaging (DTI) in 21 children and adolescents (ages 10–18 years) 5–15 years after sustaining early childhood TBI in comparison with 19 demographically-matched typically-developing children. Verbal memory and executive functioning were also evaluated and analyzed in relation to DTI metrics. Beyond the expected direction of quantitative DTI metrics in the TBI group, we also found qualitative differences in the streamline density of both pathways generated from DTI tractography in over half of those with early TBI. These children exhibited hypertrophic cingulum bundles relative to the comparison group, and the number of tract streamlines negatively correlated with age at injury, particularly in the late-developing anterior regions of the cingulum; however, streamline density did not relate to executive functioning. Although streamline density of the perforant pathway was not related to age at injury, streamline density of the left perforant pathway was significantly and positively related to verbal memory scores in those with TBI, and a moderate effect size was found in the right hemisphere. DTI tractography may provide insight into developmental plasticity in children post-injury. While traditional DTI metrics demonstrate expected relations to cognitive performance in group-based analyses, altered growth is reflected in the white matter structures themselves in some children several years post-injury. Whether this plasticity is adaptive or maladaptive, and whether the alterations are structure-specific, warrants further investigation.

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Cognitive and neurobehavioral functioning after mild versus moderate traumatic brain injury in older adults

Journal of the International Neuropsychological Society ◽

10.1017/s1355617701733115 ◽

2001 ◽

Vol 7 (3) ◽

pp. 373-383 ◽

Cited By ~ 60

Author(s):

FELICIA C. GOLDSTEIN ◽

HARVEY S. LEVIN ◽

WILLIAM P. GOLDMAN ◽

ALLISON N. CLARK ◽

TRACY KENEHAN ALTONEN

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Outcome ◽

Cognitive Measures ◽

Post Injury ◽

Mild Tbi ◽

Moderate Traumatic Brain Injury ◽

Comparable Control ◽

Neurobehavioral Outcomes

This study evaluated the early cognitive and neurobehavioral outcomes of older adults with mild versus moderate traumatic brain injury (TBI). Thirty-five patients who were age 50 years and older and sustained mild or moderate TBI were prospectively recruited from acute care hospitals. Patients were administered cognitive and neurobehavioral measures up to 2 months post-injury. Demographically comparable control participants received the same measures. Patients and controls did not have previous histories of substance abuse, neuropsychiatric disturbance, dementia, or neurologic illness. Moderate TBI patients performed significantly poorer than mild TBI patients and controls on most cognitive measures, whereas the mild patients performed comparably to controls. In contrast, both mild and moderate patients exhibited significantly greater depression and anxiety/somatic concern than controls. The results indicate that the classification of TBI as mild versus moderate is prognostically meaningful as applied to older adults. The findings extend previous investigations in young adults by demonstrating a relatively good cognitive outcome on objective measures, but subjective complaints after a single, uncomplicated mild TBI in older persons. (JINS, 2001, 7, 373–383.)

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Case Report: Buccal administration of hydrogen-producing blend after a mild traumatic brain injury in a professional athlete

F1000Research ◽

10.12688/f1000research.19739.1 ◽

2019 ◽

Vol 8 ◽

pp. 1024

Author(s):

Dejan Javorac ◽

Valdemar Stajer ◽

Sergej M. Ostojic

Keyword(s):

Traumatic Brain Injury ◽

Case Report ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Assessment Tool ◽

Initial Examination ◽

Post Injury ◽

Mild Tbi ◽

Professional Soccer ◽

Patient Reported

Background: Sport-related mild traumatic brain injury (TBI) is a serious trauma that could impair brain function of an injured athlete. Treatment solutions for mild TBI typically concentrate on complete rest, while non-traditional therapeutic options remain largely ineffective. Molecular hydrogen (H2) is an innovative neuroprotective agent that can easily reach the brain, yet no data are available concerning its value as a first-aid intervention after a mild TBI. Case report: This case report demonstrates the efficacy and safety of a hydrogen-producing dissolving tablet administered buccally during the first 24 hours post-injury in a professional soccer player who suffered a mild TBI. The patient received a formulated dosage of hydrogen every 2 hours, with the first intervention given immediately after an initial examination (~ 15 min after the injury). The overall score for Sport Concussion Assessment Tool 2 (SCAT2), a standardized method of evaluating injured athletes for concussion, increased from 68 points (severe disruption) at baseline to 84 points (mild disruption) at 24-h follow-up. The patient reported no side effects of hydrogen intervention. Conclusions: This case has demonstrated that intensive consecutive therapy with oral transmucosal hydrogen formulation is a beneficial strategy with regard to the reduction of presence and severity of symptoms of sport-related mild TBI.

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Return to Pre-Injury Work Following Mild Traumatic Brain Injury

Brain Impairment ◽

10.1017/brimp.2018.7 ◽

2018 ◽

Vol 19 (2) ◽

pp. 153-165 ◽

Cited By ~ 4

Author(s):

Michael Kahan ◽

Kelly M. Jones ◽

Shivanthi Balalla ◽

Kathryn McPherson ◽

Elisabeth Stedman ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Return To Work ◽

Population Based ◽

Post Injury ◽

Mild Tbi ◽

Prospective Longitudinal Study ◽

Younger Workers ◽

Younger Age ◽

Prospective Longitudinal

Objective: Adults are at risk for unemployment following a moderate-severe traumatic brain injury (TBI). Less is known about employment patterns following mild TBI. This study aims to examine patterns of return to pre-injury job in adults following mild TBI over a 12-month post injury period, and to investigate factors associated with return to work. Methods: It is a prospective longitudinal study of 205 adults (aged ≥16 years at injury) identified as part of a larger population-based incidence study in the Waikato, New Zealand. In-person assessments were completed at baseline (within 14 days) and 1-, 6-, and 12-month post-injury. Results: A total of 159 (77.6%) adults returned to their pre-injury job at baseline and 185 (90.2%) returned within 12 months. Of those who did not return to their pre-injury job at baseline (n= 46), younger age at injury (≤30 years,p= .02) and poor overall neurocognitive functioning at 1-month (p= .02) was associated with non-return to pre-injury job at 12 months. Conclusion: In a sample of employed adults, the majority returned to their pre-injury job shortly after injury. Cognitive functioning and younger age at time of injury may be associated with delayed return to work. Interventions to support younger workers may facilitate their return to work.

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Diverse Changes in Microglia Morphology and Axonal Pathology Over One Year after Mild Traumatic Brain Injury in Pigs

10.1101/2020.10.16.343103 ◽

2020 ◽

Author(s):

Michael R. Grovola ◽

Nicholas Paleologos ◽

Daniel P. Brown ◽

Nathan Tran ◽

Kathryn L. Wofford ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

White Matter ◽

Mild Traumatic Brain Injury ◽

Periventricular White Matter ◽

Post Injury ◽

Mild Tbi ◽

Time Points ◽

Axonal Pathology ◽

The Brain

AbstractOver 2.8 million people experience mild traumatic brain injury (TBI) in the United States each year, which may lead to long-term neurological dysfunction. The mechanical forces that occur due to TBI propagate through the brain to produce diffuse axonal injury (DAI) and trigger secondary neuroinflammatory cascades. The cascades may persist from acute to chronic time points after injury, altering the homeostasis of the brain. However, the relationship between the hallmark axonal pathology of diffuse TBI and potential changes in glial cell activation or morphology have not been established in a clinically relevant large animal model at chronic time points. In this study, we assessed tissue from pigs subjected to rapid head rotation in the coronal plane to generate mild TBI. Neuropathological assessments for axonal pathology, microglial morphological changes, and astrocyte reactivity were conducted in specimens out to 1 year post injury. We detected an increase in overall amyloid precursor protein pathology, as well as periventricular white matter and fimbria/fornix pathology after a single mild TBI. We did not detect changes in corpus callosum integrity or astrocyte reactivity. However, detailed microglial skeletal analysis revealed changes in morphology, most notably increases in the number of microglial branches, junctions, and endpoints. These subtle changes were most evident in periventricular white matter and certain hippocampal subfields, and were observed out to 1 year post injury in some cases. These ongoing morphological alterations suggest persistent change in neuroimmune homeostasis. Additional studies are needed to characterize the underlying molecular and neurophysiological alterations, as well as potential contributions to neurological deficits.

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A-145 Evaluating Attention and Processing Speed and Executive Functioning Abilities in Hispanic Traumatic Brain Injury Survivors and Healthy Adults

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.145 ◽

2020 ◽

Vol 35 (6) ◽

pp. 939-939

Author(s):

Olmos W ◽

Lopez-Hernandez D ◽

Knight J ◽

Saravia S ◽

Litvin P ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Executive Functioning ◽

Processing Speed ◽

Composite Score ◽

Post Injury ◽

Trail Making ◽

Design Fluency ◽

Main Effects ◽

Racial Ethnic

Abstract Objective We examined the effects of attention/processing speed (APS) and executive functioning (EF) in Hispanic and Caucasian traumatic brain injury (TBI) survivors and healthy comparison participants (HC). Method The sample consisted of 45 HC (21 Hispanics & 24 Caucasian), 28 acute TBI (ATBI; 10 Hispanics & 18 Caucasians), and 26 chronic TBI (CTBI; 9 Hispanics; 17 Caucasians) participants. ATBI participants were tested 6 months post-injury; CTBI participants were tested 12 months or more post-injury. Symbol Digit Modalities Test (SDMT) Oral, SDMT Written, Stroop Word, Stroop Color, and Trail Making Test (TMT) part A were used to create an APS composite (APSC) score. Stroop color-word, TMT part B, Delis-Kaplan Executive Function System verbal fluency composite score, and design fluency composite score were used to create an EF composite (EFC) score. Results ANOVAs were used to evaluate group differences. Main effects were found on APSC, p = .000, with HC and CTBI outperforming the ATBI group. Also, we found the HC group outperformed both TBI groups on EFC, p = .000. Furthermore, we found differences between racial/ethnic groups, with Caucasians outperforming Hispanics on EFC performance, p = .029. No interactions were found. Conclusion Overall, HC demonstrated better EF compared to both TBI groups, but only APS compared to the ATBI group. Also, CTBI survivors demonstrated better APS abilities compared to ATBI survivors. Our findings suggest improvement in APS during the later stages of TBI recovery. Finally, Caucasians demonstrated better EF compared to Hispanics.

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