scholarly journals Association of gut microbiota with cerebral cortex and cerebrovascular abnormality in human mild traumatic brain injury

2020 ◽  
Author(s):  
Lijun Bai ◽  
Tianhui Li ◽  
Ming Zhang ◽  
Shan Wang ◽  
Shuoqiu Gan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Gut Microbiota ◽  
Mild Traumatic Brain Injury ◽  
Small Sample Size ◽  
Small Sample ◽  
Diagnostic Model ◽  
Mild Tbi ◽  
Cerebrovascular Injury ◽  
Α Diversity

AbstractKey roles of the gut–brain axis in brain injury development have been suggested in various mouse models; however, little is known about its functional significance in human mild traumatic brain injury (TBI). Here, we decipher this axis by profiling the gut microbiota in 98 acute mild TBI patients and 62 matched controls, and subgroup of them also measured circulating mediators and applied neuroimaging. Mild TBI patients had increased α-diversity and different overall microbial compositions compared with controls. 25-microbial genus classifiers distinguish patients from controls with an area under the receiver operating characteristic curve (AUC) of 0.889, while adding serum mediators and neuroimaging features further improved performance even in a small sample size (AUC = 0.969). Numerous correlations existed between gut bacteria, aberrant cortical thickness and cerebrovascular injury. Co-occurrence network analysis revealed two unique gut–brain axes in patients: 1) altered intestinal Lachnospiraceae_NK4A136_group and Eubacterium_ruminantium_group-increased serum GDNF-subcallosal hypertrophy and cerebrovascular injury; 2) decreased intestinal Eubacterium_xylanophilum_group–upregulated IL-6–thinned anterior insula. Our findings provide a new integrated mechanistic understanding and diagnostic model of mild TBI.

Analysis of Story Recall in Military Veterans With and Without Mild Traumatic Brain Injury: Preliminary Results

2018 ◽  
Vol 27 (1S) ◽  
pp. 485-494
Author(s):  
Karen Gallagher ◽  
Tamiko Azuma
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Recall Performance ◽  
Small Sample Size ◽  
Military Veterans ◽  
Small Sample ◽  
Control Group ◽  
Story Recall ◽  
History Of

Purpose The purpose of this study was to determine whether detailed analysis of story recall performance reveals significant differences between veterans with and without history of mild traumatic brain injury (mTBI). Method Twenty-one military veterans participated, with 7 reporting history of mTBI. All participants were administered the Logical Memory I and II subtests from the Wechsler Memory Scale–Fourth Edition (Wechsler, 2009). Responses were scored for total correct ideas (TCI) and total words produced (TWP). Results Although the groups did not differ in scaled scores, other measures did reveal significant differences. After a delay, the mTBI group showed a greater drop in TCI relative to the control group. Additionally, the control group showed an increase in TWP when the recall was delayed versus immediate; a pattern not observed for the mTBI group. Conclusions The mTBI and control groups did not significantly differ in scaled scores. However, group differences were observed in TCI and TWP. The findings suggest that, relative to the control group, the mTBI group were less successful in retrieving episodic information and eliciting self-cueing. Small sample size limited data interpretation, and larger sample sizes are needed to confirm the findings. The results indicate that veterans with mTBI may present with symptoms persisting beyond the acute state of the injury.

Preinjury Psychological Factors and Case Formulation in Mild Traumatic Brain Injury Rehabilitation: A Case Report

2019 ◽  
Vol 63 (3) ◽  
pp. 156-167 ◽  
Author(s):  
Joanne E. Taylor ◽  
Renée F. Seebeck
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Psychological Factors ◽  
Illustrative Case ◽  
Case Formulation ◽  
Treatment Team ◽  
Mild Tbi ◽  
Case Examples ◽  
Rehabilitation Professionals

Mild traumatic brain injury (TBI) accounts for the majority of TBIs. Most cases recover within 3 months and usual medical advice covers physical and cognitive rest, activity and fatigue management, and education. However, in some cases, symptoms can persist and there may be ongoing postconcussion difficulties. It is well established that pre- and postinjury psychological factors can contribute to cases of persistent postconcussion symptoms. However, there are few illustrative case examples in the published literature on mild TBI. This case example demonstrates the pivotal role that preinjury psychological factors can play in recovery from mild TBI, using an example of a 35-year-old woman with persistent mild TBI symptoms who had a limited response to previous brief treatment through a Concussion Clinic. Through the process of assessment and development of a psychological case formulation, preinjury psychological factors that had been barriers to recovery and prior rehabilitation efforts were identified. Rehabilitation counselors are equipped to (1) identify and address such barriers, (2) communicate this information to other rehabilitation professionals in the treatment team to facilitate a shared understanding of how factors might affect the client’s functioning and (3) contribute to team case formulation.

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

2011 ◽  
Vol 17 (2) ◽  
pp. 317-326 ◽  
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)

scholarly journals The role of deficient pain modulatory systems in the development of persistent post-traumatic headaches following mild traumatic brain injury: an exploratory longitudinal study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kelly M. Naugle ◽  
Christopher Carey ◽  
Eric Evans ◽  
Jonathan Saxe ◽  
Ryan Overman ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Pain Catastrophizing ◽  
Pain Modulation ◽  
Conditioned Pain Modulation ◽  
Mild Tbi ◽  
Inhibitory Capacity ◽  
Pressure Pain Thresholds ◽  
Post Traumatic

Abstract Background Post-traumatic headache (PTH) is one of the most common and long-lasting symptoms following mild traumatic brain injury (TBI). However, the pathological mechanisms underlying the development of persistent PTH remain poorly understood. The primary purpose of this prospective pilot study was to evaluate whether early pain modulatory profiles (sensitization and endogenous pain inhibitory capacity) and psychological factors after mild TBI predict the development of persistent PTH in mild TBI patients. Methods Adult mild TBI patients recruited from Level I Emergency Department Trauma Centers completed study sessions at 1–2 weeks, 1-month, and 4-months post mild TBI. Participants completed the following outcome measures during each session: conditioned pain modulation to measure endogenous pain inhibitory capacity, temporal summation of pain and pressure pain thresholds of the head to measure sensitization of the head, Pain Catastrophizing Scale, Center for Epidemiological Studies – Depression Scale, and a standardized headache survey. Participants were classified into persistent PTH (PPTH) and no-PPTH groups based on the 4-month data. Results The results revealed that mild TBI patients developing persistent PTH exhibited significantly diminished pain inhibitory capacity, and greater depression and pain catastrophizing following injury compared to those who do not develop persistent PTH. Furthermore, logistic regression indicated that headache pain intensity at 1–2 weeks and pain inhibitory capacity on the conditioned pain modulation test at 1–2 weeks predicted persistent PTH classification at 4 months post injury. Conclusions Overall, the results suggested that persistent PTH is characterized by dysfunctional alterations in endogenous pain modulatory function and psychological processes in the early stages following mild TBI, which likely exacerbate risk for the maintenance of PTH.

scholarly journals Sleep disturbances after pediatric traumatic brain injury: a systematic review of prevalence, risk factors, and association with recovery

SLEEP ◽  
2020 ◽  
Vol 43 (10) ◽  
Author(s):  
Madison Luther ◽  
Katrina M Poppert Cordts ◽  
Cydni N Williams
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sleep Disturbances ◽  
Small Sample Size ◽  
Evaluation Studies ◽  
Small Sample ◽  
Risk Of Bias ◽  
Pediatric Tbi

Abstract Study Objectives Sleep is vital for brain development and healing after injury, placing children with sleep-wake disturbances (SWD) after traumatic brain injury (TBI) at risk for worse outcomes. We conducted a systematic review to quantify SWD after pediatric TBI including prevalence, phenotypes, and risk factors. We also evaluated interventions for SWD and the association between SWD and other posttraumatic outcomes. Methods Systematic searches were conducted in MEDLINE, PsychINFO, and reference lists for English language articles published from 1999 to 2019 evaluating sleep or fatigue in children hospitalized for mild complicated, moderate, or severe TBI. Two independent reviewers assessed eligibility, extracted data, and assessed risk of bias using the Newcastle–Ottowa Score for observational studies. Results Among 966 articles identified in the search, 126 full-text articles were reviewed, and 24 studies were included (11 prospective, 9 cross-sectional, and 4 case studies). Marked heterogeneity was found in study populations, measures defining SWD, and time from injury to evaluation. Studies showed at least 20% of children with TBI had trouble falling or staying asleep, fatigue, daytime sleepiness, and nightmares. SWD are negatively correlated with posttraumatic cognitive, behavioral, and quality of life outcomes. No comparative intervention studies were identified. The risk of bias was moderate–high for all studies often related to lack of validated or objective SWD measures and small sample size. Heterogeneity precluded meta-analyses. Conclusions SWD are important morbidities after pediatric TBI, though current data are limited. SWD have implications for TBI recovery and may represent a modifiable target for improving outcomes after pediatric TBI.

scholarly journals B-72 The Relationship between Anxiety and Postconcussive Symptomology in patients with Mild Traumatic Brain Injury

2019 ◽  
Vol 34 (6) ◽  
pp. 1020-1020
Author(s):  
K Cornett
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Injury Severity ◽  
Small Sample ◽  
Future Research ◽  
Control Group ◽  
Patient Report ◽  
The Relationship ◽  
Report Measure

Abstract Objective Research literature has demonstrated the role that pre-morbid anxiety has in prolonging recovery from mild traumatic brain injury (mTBI). The aim of this investigation is to clarify the degree of the relationship between anxiety and postconcussive symptomology in patients with mTBI. Method This study compared scores from a patient-report measure of anxiety, the General Anxiety Disorder-7 (GAD-7), to scores from a patient-report measure of postconcussion symptom severity, the Neurobehavioral Symptom Inventory (NSI). Participants were recruited from September 2018 to December 2019 who had been referred for clinical evaluation to Rehabilitation Institute of Washington’s Brain Injury Services (a privately-run, interdisciplinary, outpatient clinic). 39 adult participants (30 males and nine females) completed both the GAD-7 and NSI. No control group was used. Injury severity level was ascertained via review of the medical records. Patients underwent an abbreviated evaluation with a clinical neuropsychologist. As a part of this initial evaluation, patients completed an intake packet, which included the NSI and GAD-7. Results The relationship between the ordinal variables (i.e., anxiety and postconscussive symptomology) was assessed using spearman’s rho. Anxiety had a strong, statistically significant relationship with postconcussive symptomology (rho = 0.670, p = 0.000). Conclusions Anxiety and postconcussive symptomology severity are associated in this population of patients with mTBI. Limitations of this current investigation include a small sample size and no control group. This study indicates the need for controlled studies in future research to address the above-encountered limitations. Nevertheless, this study lends support to the prevalence of anxiety in those with elevated postconcussive symptomology and the need to monitor this in assessment and treatment.

A-117 Strategic Memory and Advanced Reasoning Training for Rehabilitation of Warfighters with Mild Traumatic Brain Injury

2021 ◽  
Vol 36 (6) ◽  
pp. 1167-1167
Author(s):  
Jason Bailie ◽  
Paul Sargent ◽  
Sandi Chapman ◽  
Melissa Caswell ◽  
Juan Lopez ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Executive Functioning ◽  
Mild Traumatic Brain Injury ◽  
Cognitive Abilities ◽  
High Stress ◽  
Small Sample ◽  
Cognitive Complaints ◽  
Relevant Effect ◽  
Strategic Memory

Abstract Background Military personnel require a level of cognitive readiness that ensures they function safely and effectively in high-stress situations. Warfighters who experienced a mild traumatic brain injury (mTBI) often complain of persistent cognitive issues that may impact those abilities. This study presents preliminary data on the efficacy of a 4-week Strategic Memory Advanced Reasoning Training (SMART) for warfighter rehabilitation. SMART improves executive functioning in order to enhance overall cognitive abilities. Methods This is part of a randomized clinical trial (Validation of Cognitive Enhancement Therapy for mTBI). 22 Marines with prior mTBI and current cognitive complaints; 7 of whom completed SMART and were included in the analysis. Cognitive tests of interest included the Delis-Kaplan Executive Function System Color Word (CW) and Trail Making (TM). Results Improvements were observed on TM Number Sequencing (Pre: M = 9.71, SD = 2.06; Post: M = 11.86, SD = 1.35, p = 0.011, d = 1.37) and approached significance on Letter Sequencing (Pre: M = 10.29, SD = 1.81; Post: M = 12.57, SD = 1.13, p = 0.066, d = 1.26). Though non-significant, a large clinically-relevant effect size was found for Number-Letter Switching (Pre: M = 8.14, SD = 1.95; Post: M = 9.57, SD = 2.15, p = 0.106, d = 0.72). CW performance improved on Inhibition (Pre: M = 5.29, SD = 3.86; Post: M = 8.86, SD = 2.34, p = 0.034, d = 1.03) and Inhibition/Switching (Pre: M = 4.86, SD = 4.06; Post: M = 8.43, SD = 4.12, p = 0.015, d = 1.26). Conclusions The SMART program resulted in large improvements in the executive functioning of a small sample of warfighters with persistent cognitive complaints following a mTBI. The results support further examination of the efficacy of SMART for warfighter rehabilitation.

A cost-effectiveness and value of information analysis to inform future research of tranexamic acid for older adults experiencing mild traumatic brain injury

2021 ◽  
Author(s):  
Jack Williams ◽  
Katharine Ker ◽  
Ian Roberts ◽  
Haleema Shakur-Still ◽  
Alec Miners
Keyword(s):  
Traumatic Brain Injury ◽  
Cost Effectiveness ◽  
Brain Injury ◽  
Tranexamic Acid ◽  
Mild Traumatic Brain Injury ◽  
Cost Effective ◽  
Future Research ◽  
Base Case ◽  
Mild Tbi ◽  
Value Of Perfect Information

Abstract Background Tranexamic acid reduces head injury deaths in patients with CT scan evidence of intracranial bleeding after mild traumatic brain injury (TBI). However, the cost-effectiveness of tranexamic acid for people with mild TBI in the pre-hospital setting, prior to CT scanning, is uncertain. A large randomised controlled trial (CRASH-4) is planned to address this issue, but the economic justification for it has not been established. The aim of the analysis was to estimate the likelihood of tranexamic acid being cost-effective given current evidence, the treatment effects required for cost-effectiveness, and the expected value of performing further research. Methods An early economic decision model compared usual care for mild TBI with and without tranexamic acid, for adults aged 70 and above. The evaluation was performed from a UK healthcare perspective over a lifetime time horizon, with costs reported in 2020 pounds (GBP) and outcomes reported as quality adjusted life years (QALYs). All analyses used a £20,000 per QALY cost-effectiveness threshold. Results In the base case analysis, tranexamic acid was associated with an incremental cost-effectiveness ratio of £4,994 per QALY gained, and was 85% likely to be cost-effective in the base case probabilistic sensitivity analysis. The value of perfect information was £13.2 million, and the value of perfect information for parameters that could be collected in a trial was £12.4 million. The all-cause mortality risk ratio for tranexamic acid and the functional outcomes following TBI had the most impact on cost-effectiveness. Conclusions Tranexamic acid can be cost-effective at a very modest treatment effect, and there is a high value of performing future research in the UK. The value in a global context is likely to be far higher.

Effects of Pediatric Traumatic Brain Injury on Verbal IQ: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-13
Author(s):  
Carly A. Cermak ◽  
Shannon E. Scratch ◽  
Nick P. Reed ◽  
Lisa Kakonge ◽  
Deryk S. Beal
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Small Sample ◽  
Extensive Literature ◽  
Pediatric Traumatic Brain Injury ◽  
Mild Tbi ◽  
Verbal Iq ◽  
Statistical Heterogeneity

Abstract Objectives: To examine the effects of pediatric traumatic brain injury (TBI) on verbal IQ by severity and over time. Methods: A systematic review and subsequent meta-analysis of verbal IQ by TBI severity were conducted using a random effects model. Subgroup analysis included two epochs of time (e.g., <12 months postinjury and ≥12 months postinjury). Results: Nineteen articles met inclusion criteria after an extensive literature search in MEDLINE, PsycInfo, Embase, and CINAHL. Meta-analysis revealed negative effects of injury across severities for verbal IQ and at both time epochs except for mild TBI < 12 months postinjury. Statistical heterogeneity (i.e., between-study variability) stemmed from studies with inconsistent classification of mild TBI, small sample sizes, and in studies of mixed TBI severities, although not significant. Risk of bias on estimated effects was generally low (k = 15) except for studies with confounding bias (e.g., lack of group matching by socio-demographics; k = 2) and measurement bias (e.g., outdated measure at time of original study, translated measure; k = 2). Conclusions: Children with TBI demonstrate long-term impairment in verbal IQ, regardless of severity. Future studies are encouraged to include scores from subtests within verbal IQ (e.g., vocabulary, similarities, comprehension) in addition to functional language measures (e.g., narrative discourse, reading comprehension, verbal reasoning) to elucidate higher-level language difficulties experienced in this population.

Visual Dysfunction in Combat-related Mild Traumatic Brain Injury—A Review

US Neurology ◽  
2013 ◽  
Vol 09 (01) ◽  
pp. 61 ◽  
Author(s):  
M Teresa Magone ◽  
Glenn C Cockerham ◽  
Soo Y Shin ◽  
◽  
◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Military Personnel ◽  
Patient Population ◽  
Visual Dysfunction ◽  
Mild Tbi ◽  
Near Vision ◽  
Presenting Symptoms ◽  
Oculomotor Function

Approximately half of all military personnel who have served in the conflicts in Iraq and Afghanistan are reported to have some degree of combat-related mild traumatic brain injury (TBI). Although in civilian concussion injuries symptoms typically resolve within several weeks, blast-induced mild TBI may be accompanied by prolonged symptoms and afferent and efferent visual dysfunction. Most commonly near vision problems and photophobia are the presenting symptoms. A complete eye exam including vision testing, oculomotor function, and near tasking, is highly recommended after blast-induced mild TBI to detect and improve symptoms in this young patient population. A review of the current literature is presented.

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