Autonomic Dysfunction and Associations with Functional and Neurophysiological Outcome in Moderate/Severe Traumatic Brain Injury: A Scoping Review

Background and Objective: Survivors of moderate-severe traumatic brain injury (msTBI) frequently experience chronic, debilitating somatic symptoms, which are largely unexplained. The phenomenon of paroxysmal sympathetic hyperactivity, reflecting hyperacute autonomic dysfunction, is well-documented after msTBI. Limited animal and human studies, using experimental measures, have found evidence for autonomic dysfunction after msTBI. However, no studies have investigated the range and type of autonomic symptoms and autonomic dysfunction existing in msTBI. We set out to investigate the presence and type of subjective and objective autonomic dysfunction in msTBI. Methods: We conducted two cohort studies. Cohort 1 comprises msTBI patients prospectively recruited from a regional TBI outpatient clinic, in whom we assessed burden of autonomic symptoms using the Composite Autonomic Symptom Score (COMPASS31) autonomic symptom questionnaire. Cohort 2 comprises msTBI patients who had standard clinical autonomic function testing (supine/tilted catecholamine levels, head-up tilt, Valsalva manoeuvre, respiratory sinus arrhythmia assessment), retrospectively identified from the database of a regional clinical autonomic unit. Results: Cohort 1 comprises 29 msTBI patients (6 females, median age 40 years, range 19-76), with a median time since injury of 19 months (range 4-105). There was multi-domain symptom burden, with all but 3 patients reporting symptoms on the COMPASS31 questionnaire, and 17/29 reporting symptoms in 3+ domains. The most commonly reported symptoms were gastrointestinal (22/29), followed by orthostatic (17/19), pupillomotor (14/29), secretomotor (14/29), bladder (12/29) and, least commonly, vasomotor (6/29). Cohort 2 comprises 19 msTBI patients (7 females, median age 44 years, range 21-64), with a median time between injury and testing of 65 months (range: 2-416). The majority of patients (16/19) had orthostatic symptoms as part of the reason for referral. Clinical autonomic function testing revealed a broad spectrum of autonomic dysfunction: 4/19 had evidence of sympathetic dysfunction, 10/19 had evidence of parasympathetic dysfunction, of which 6 had evidence of mixed dysfunction. Discussion: Our results provide evidence for clinically relevant autonomic dysfunction after moderate-severe TBI, even at the chronic stage. Our study advocates for routine enquiry about potential autonomic symptoms in this population, and the utility of formal clinical autonomic testing in providing diagnoses.

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Remote Rehabilitation for Survivors of Moderate or Severe Traumatic Brain Injury: A Scoping Review

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.08.465 ◽

2019 ◽

Vol 100 (10) ◽

pp. e152-e153

Author(s):

Jennifer O'Neil ◽

Jacquie van Ierssel ◽

Heidi Sveistrup

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Scoping Review

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Community-Based Physical Activity Interventions for Individuals with Moderate to Severe Traumatic Brain Injury: Scoping Review Protocol (Preprint)

10.2196/preprints.24689 ◽

2020 ◽

Author(s):

Enrico Quilico ◽

Bonnie Swaine ◽

Christophe Alarie ◽

Angela Colantonio

Keyword(s):

Physical Activity ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Scoping Review ◽

Current Evidence ◽

Future Research ◽

Sex And Gender ◽

Community Based ◽

Severe Tbi

BACKGROUND Long-term physical, cognitive, and psychosocial problems resulting from moderate to severe traumatic brain injury (TBI) can prevent individuals from returning to preinjury lifestyles because of significant challenges with employment, leisure, and relationships. While physical activity (PA) is proposed as a cost-effective method to alleviate problems after moderate to severe TBI, there is no review to date that synthesizes the evidence for PA in the community-based context. Further, although sex- and gender-based considerations in research are considered requisite to good science, there is no review on PA and TBI that has included this explicit focus. OBJECTIVE The purpose of this review is to map and synthesize the current evidence identified through a systematic search of community-based PA interventions for individuals of all ages with moderate to severe TBI and provide an overview of that evidence by asking the following research questions: (1) what are the characteristics of community-based PA programs for individuals with moderate to severe TBI, (2) what are the reported health-related outcomes and measurement tools used to evaluate them, and (3) what considerations have been given to sex and/or gender? METHODS Searches will be conducted of six academic databases for peer-reviewed articles. Two reviewers will independently screen the articles for inclusion and extract data for the analysis. The extracted data will be coded according to the Consensus on Exercise Reporting Template checklist and the Template for Intervention Description and Replication checklist to provide sufficient detail for replication. RESULTS The abstract screening was completed by two reviewers and the extracted data were analyzed. A qualitative synthesis and description of community-based PA interventions for individuals with moderate to severe TBI will be provided. CONCLUSIONS This scoping review will generate new knowledge from published and publicly available literature. Dissemination of the results will include activities related to knowledge transfer for community-based PA after moderate to severe TBI for future research and practice. Evidence-based recommendations, future directions, potential limitations, use of online/digital components, and the possible need for a systematic review will be discussed as well. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/24689

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Community-Based Physical Activity Interventions for Individuals with Moderate to Severe Traumatic Brain Injury: Scoping Review Protocol

JMIR Research Protocols ◽

10.2196/24689 ◽

2021 ◽

Vol 10 (1) ◽

pp. e24689

Author(s):

Enrico Quilico ◽

Bonnie Swaine ◽

Christophe Alarie ◽

Angela Colantonio

Keyword(s):

Physical Activity ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Scoping Review ◽

Current Evidence ◽

Future Research ◽

Sex And Gender ◽

Community Based ◽

Severe Tbi

Background Long-term physical, cognitive, and psychosocial problems resulting from moderate to severe traumatic brain injury (TBI) can prevent individuals from returning to preinjury lifestyles because of significant challenges with employment, leisure, and relationships. While physical activity (PA) is proposed as a cost-effective method to alleviate problems after moderate to severe TBI, there is no review to date that synthesizes the evidence for PA in the community-based context. Further, although sex- and gender-based considerations in research are considered requisite to good science, there is no review on PA and TBI that has included this explicit focus. Objective The purpose of this review is to map and synthesize the current evidence identified through a systematic search of community-based PA interventions for individuals of all ages with moderate to severe TBI and provide an overview of that evidence by asking the following research questions: (1) what are the characteristics of community-based PA programs for individuals with moderate to severe TBI, (2) what are the reported health-related outcomes and measurement tools used to evaluate them, and (3) what considerations have been given to sex and/or gender? Methods Searches will be conducted of six academic databases for peer-reviewed articles. Two reviewers will independently screen the articles for inclusion and extract data for the analysis. The extracted data will be coded according to the Consensus on Exercise Reporting Template checklist and the Template for Intervention Description and Replication checklist to provide sufficient detail for replication. Results The abstract screening was completed by two reviewers and the extracted data were analyzed. A qualitative synthesis and description of community-based PA interventions for individuals with moderate to severe TBI will be provided. Conclusions This scoping review will generate new knowledge from published and publicly available literature. Dissemination of the results will include activities related to knowledge transfer for community-based PA after moderate to severe TBI for future research and practice. Evidence-based recommendations, future directions, potential limitations, use of online/digital components, and the possible need for a systematic review will be discussed as well. International Registered Report Identifier (IRRID) DERR1-10.2196/24689

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Demonstration of subclinical autonomic dysfunction following severe traumatic brain injury using serial heart rate variability monitoring

Autonomic Neuroscience ◽

10.1016/j.autneu.2015.07.088 ◽

2015 ◽

Vol 192 ◽

pp. 81

Author(s):

A. Deepika ◽

S. Baruah ◽

D.P. Shukla ◽

T.N. Sathyaprabha ◽

B.I. Devi

Keyword(s):

Traumatic Brain Injury ◽

Heart Rate ◽

Heart Rate Variability ◽

Brain Injury ◽

Autonomic Dysfunction ◽

Severe Traumatic Brain Injury

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Remote supervision of rehabilitation interventions for survivors of moderate or severe traumatic brain injury: A scoping review

Journal of Telemedicine and Telecare ◽

10.1177/1357633x19845466 ◽

2019 ◽

Vol 26 (9) ◽

pp. 520-535 ◽

Cited By ~ 1

Author(s):

Jennifer O’Neil ◽

Jacquie van Ierssel ◽

Heidi Sveistrup

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Rural Communities ◽

Outcome Measures ◽

Severe Traumatic Brain Injury ◽

Scoping Review ◽

Clinical Implementation ◽

Intervention Delivery ◽

Remote Supervision ◽

Severe Tbi

Introduction Individuals with moderate or severe traumatic brain injury (TBI) often have persistent impairments upon discharge home. In rural communities, specialized rehabilitation services to address impairments can be difficult to access. The purpose of this scoping review is to examine how remote supervision is currently being used in TBI rehabilitation to identify gaps in knowledge that need to be addressed to facilitate access to and implementation of these services. Methods The main objective for this review is to identify the methods being used to deliver remote supervision for rehabilitation in a moderate or severe TBI population. The aim of this review was to document the implementation characteristics of remote supervision used including: (1) type of supervision such as synchronous, asynchronous supervision or mixed; (2) frequency and intensity of remote supervision; and (3) outcomes used to measure intervention delivery as well as effectiveness within this population. This scoping review follows EQUATOR Network recommendations for screening and extracting data. Results Twenty-six studies using a variety of remote supervision technology and outcome measures were included. Supervision frequency and intensity are poorly reported with no standardization. One hundred and six outcome measures were reported in this review showing large diversity in the areas being explored. Discussion Different types of remote supervision have been used with this population; however, there are no clear guidelines on clinical implementation. Future studies must better define implementation parameters of remote supervision. Benefit on physical activity, balance and mobility outcomes also need to be further explored.

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