Head Stabilization During Standing in People with Persisting Symptoms after Mild Traumatic Brain Injury

ABSTRACTIncreased postural sway is often observed in people with mild traumatic brain injury (mTBI), but our understanding of how individuals with mTBI control their head during stance is limited. The purpose of this study was to determine if people with mTBI exhibit increased sway at the head compared with healthy controls. People with persisting symptoms after mTBI (n = 59, 41 women) and control participants (n = 63, 38 women) stood quietly for one minute in four conditions: eyes open on a firm surface (EO-firm), eyes closed on a firm surface (EC-firm), eyes open on a foam pad (EO-foam), and eyes closed on foam (EC-foam). Inertial sensors at the head, sternum, and lumbar region collected tri-axial accelerations. Root-mean-square (RMS) accelerations in anteroposterior (AP) and mediolateral (ML) directions. Sway ratios between the head and sternum, head and lumbar, and sternum and lumbar region, were compared between groups. Temporal coupling of anti-phase motion between the upper and lower body angular accelerations was assessed with magnitude squared coherence and cross-spectral phase angles. People with mTBI demonstrated greater sway than controls across conditions and directions. During foam-surface conditions, the control group, but not the mTBI group, reduced ML sway at their head and trunk relative to their lumbar by increasing the expression of an anti-phase hip strategy within the frontal plane. These results are consistent with suggestions of inflexible or inappropriate postural control in people with mTBI.

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Centre of pressure during quiet stance and dual-task one month after mild traumatic brain injury: In adolescents

Journal of Concussion ◽

10.1177/2059700218804917 ◽

2018 ◽

Vol 2 ◽

pp. 205970021880491 ◽

Cited By ~ 1

Author(s):

Coren Walters-Stewart ◽

Coralie Rochefort ◽

Andre Longtin ◽

Roger Zemek ◽

Heidi Sveistrup

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Dual Task ◽

Temporal Organization ◽

Quiet Stance ◽

Centre Of Pressure ◽

Eyes Closed ◽

Eyes Open

Background Mild traumatic brain injury is a common neurological condition affecting adolescents in North America. In adults, symptoms related to balance are some of the most commonly reported. Methods The purpose of this study was to investigate the balance in adolescents with mild traumatic brain injury using linear and non-linear centre of pressure (COP) measures in quiet stance and during dual-task. Adolescents aged 13.00 to 17.99 years were tested once at one month following mild traumatic brain injury (n = 25), and healthy adolescents (n = 22) were tested once as controls in four conditions: standing with eyes open, standing with eyes closed, standing on a single leg and standing while performing a visual Stroop task. Results In general, compared to healthy adolescents, adolescents with mild traumatic brain injury demonstrated more variability ( p = 0.007, 95% CI (0.9, 5.4) and p = 0.049, 95% CI (0.009, 4.0), mediolateral and anteroposterior, respectively), showed more cumulative movement (path length, p = 0.016, 95% CI (1.3, 11.9)) and required greater speed of movement ( p = 0.012, 95% CI (0.99, 7.4) and p = 0.035, 95% CI (0.28, 7.5), mediolateral and anteroposterior, respectively) in maintaining balance, and in underlying temporal organization showed less local stability (mediolateral largest Lyapunov, p = 0.033, 95% CI (0.001, 0.027)), more short-term complexity anteroposteriorly ( p = 0.029, 95% CI (0.005, 0.099)) and less long-term complexity mediolaterally ( p = 0.001, 95% CI (0.015, 0.056)). Condition differences are additionally presented. Conclusions Findings suggest that, for adolescents with mild traumatic brain injury, when maintaining balance visual input is relied on differently, the effectiveness of control may be an issue during dual-task, and consequently, the challenge of dual-task may be on par with single leg stance.

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Elevated levels of serum, but not salivary, brain-derived neurotrophic factor following mild traumatic brain injury in collegiate athletes post return-to-play

Journal of Concussion ◽

10.1177/2059700219894108 ◽

2019 ◽

Vol 3 ◽

pp. 205970021989410

Author(s):

Taylor R Susa ◽

Ryan D Brandt ◽

Keara J Kangas ◽

Catherine E Bammert ◽

Erich N Ottem ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Neurotrophic Factor ◽

Collegiate Athletes ◽

Brain Derived Neurotrophic Factor ◽

Return To Play ◽

Control Group ◽

The Relationship ◽

Serum Bdnf

Brain-derived neurotrophic factor (BDNF) helps restore neuronal function following mild traumatic brain injury. BDNF levels can be obtained in blood serum and more recently in saliva. However, the relationship between serum and salivary BDNF is poorly understood—especially in relation to alterations in BDNF levels following mild traumatic brain injury. In this study, serum and salivary BDNF were collected from a sample of 42 collegiate student athletes. Half of the participants were recently cleared by a physician and/or an athletic trainer to return-to-play after experiencing a sports-related concussion. The other half had not experienced a concussion within the past year and were matched by age, sex, sport, and time of sample. Results suggest that incidences of depression, anxiety, and stress were all elevated in the concussion group, relative to the control participants. When controlling for stress-related negative affect, serum BDNF was elevated in the concussion group. However, there was no difference in salivary BDNF. Serum and salivary BDNF were uncorrelated across the entire sample. Yet, these measures of BDNF were correlated in the concussion group, but not the control group. In sum, serum BDNF is elevated in concussion post return-to-play; however, further research is needed to explore the utility of salivary BDNF following concussion.

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Diagnostic Approach to Traumatic Axonal Injury of the Spinothalamic Tract in Individual Patients with Mild Traumatic Brain Injury

Diagnostics ◽

10.3390/diagnostics9040199 ◽

2019 ◽

Vol 9 (4) ◽

pp. 199 ◽

Cited By ~ 3

Author(s):

Jang ◽

Lee

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Axonal Injury ◽

Control Group ◽

Central Pain ◽

Traumatic Axonal Injury ◽

Spinothalamic Tract ◽

Statistical Comparison ◽

Control Subjects

Objectives: We investigated an approach for the diagnosis of traumatic axonal injury (TAI) of the spinothalamic tract (STT) that was based on diffusion tensor tractography (DTT) results and a statistical comparison of individual patients who showed central pain following mild traumatic brain injury (mTBI) with the control group. Methods: Five right-handed female patients in their forties and with central pain following mTBI and 12 age-, sex-, and handedness-matched healthy control subjects were recruited. After DTT reconstruction of the STT, we analyzed the STT in terms of three DTT parameters (fractional anisotropy (FA), mean diffusivity (MD), and fiber number (FN)) and its configuration (narrowing and tearing). To assess narrowing, we determined the area of the STT on an axial slice of the subcortical white matter. Results: the FN values were significantly lower in at least one hemisphere of each patient when compared to those of the control subjects (p < 0.05). Significant decrements from the STT area in the control group were observed in at least one hemisphere of each patient (p < 0.05). Regarding configurational analysis, the STT showed narrowing and/or partial tearing in at least one hemisphere of each of the five patients. Conclusions: Herein, we demonstrate a DTT-based approach for the diagnosis of TAI of the STT. The approach involves a statistical comparison between DTT parameters of individual patients who show central pain following mTBI and those of an age-, gender-, and handedness-matched control group. We think that the method described in this study can be useful in the diagnosis of TAI of the STT in individual mTBI patients.

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EVALUATION OF CARDIOVASCULAR DYSREGULATION IN PATIENTS AFTER HEMORRHAGIC STROKE AS A COMPLICATION OF ESSENTIAL HYPERTENSION

Ukrainian Scientific Medical Youth Journal ◽

10.32345/usmyj.3(125).2021.32-43 ◽

2021 ◽

Vol 125 (3) ◽

pp. 32-43

Author(s):

Oleksandr Tkachyshyn

Keyword(s):

Blood Pressure ◽

Traumatic Brain Injury ◽

Essential Hypertension ◽

Brain Injury ◽

Systolic Blood Pressure ◽

Mild Traumatic Brain Injury ◽

Hemorrhagic Stroke ◽

Blood Pressure Monitoring ◽

Main Group ◽

Control Group

The aim of the study was to compare blood pressure and electrocardiogram indices, assessed by their daily monitoring, and anamnestic data on mild traumatic brain injury between a group of patients with essential hypertension ≥6 months after a hemorrhagic stroke and a group of patients with essential hypertension without complications. Materials and methods. The total number of examined patients was 198 people, who were divided into 2 groups: the main (n = 94; age – 54,4±8,8 years, M±σ years) and the control (n = 104; age – 53,7±8,9 years) one. Patients in the main group suffered a hemorrhagic stroke as a complication of essential hypertension ≥6 months ago. The control group included patients with essential hypertension, stage II. In both groups of patients, the parameters of 24-hour ambulatory blood pressure monitoring and electrocardiogram were determined. Results. The indices of 24-hour ambulatory blood pressure monitoring in the main group and the control group were the following ones, respectively: the mean daytime systolic blood pressure was 109,6±1,6 and 121,1±1,1 mm Hg, the minimal one was 74,4±2,0 mm Hg and 82,3±12,5 mm Hg, and the maximal one was 168,2±1,9 and 161,9±1,7 mm Hg, p<0,05. The daytime sigma systolic blood pressure (17,9±0,6) and its average real variability of (11,31±2,52 mm Hg) were bigger in the main group (p<0,05). The daytime index of the hyperbaric load of systolic blood pressure was bigger in the main group: it was 403,6±25,9 against 231,7±12,1 mm Hg×h in the comparison group (p<0,05). The mean, minimum and maximum heart rate at night were significantly lower in the main group (p<0,05). The QTcmin index was significantly lower in the main group in contrast to the control one – 286,28±43,34 and 336,69±22,55, and the QT variance was greater – 232,56±44,55 – in comparison to the control group (188,31±33,67) (p<0,05). From the anamnestic data of patients, a significantly higher prevalence of mild traumatic brain injury was found in 37,4% (35 patients out of 94) in the main group relative to the control one – 13,5% (14 out of 104), p<0,05. Conclusions: The results of the study indicate the larger ranges of blood pressure variability in patients with essential hypertension complicated with hemorrhagic stroke, which can be caused by impaired autoregulation according to the QTc interval data. In combination with the disturbances of cerebral circulation, caused by the injury of the brain due to the hemorrhagic stroke alone or in combination with mild traumatic brain injury episode, such a situation may lead to the development of recurrent stroke.

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Examining Microstructural White Matter in Active Duty Soldiers with a History of Mild Traumatic Brain Injury and Traumatic Stress

The Open Neuroimaging Journal ◽

10.2174/1874440001711010046 ◽

2017 ◽

Vol 11 (1) ◽

pp. 46-57 ◽

Cited By ~ 7

Author(s):

Michael N. Dretsch ◽

Rael T. Lange ◽

Jeffery S. Katz ◽

Adam Goodman ◽

Thomas A. Daniel ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

White Matter ◽

Mild Traumatic Brain Injury ◽

Psychological Health ◽

Traumatic Stress ◽

Diffusion Tensor ◽

Active Duty ◽

Control Group ◽

History Of

Background:There is a high comorbidity of posttraumatic stress (PTS) and mild traumatic brain injury (mTBI), with largely overlapping symptomatology, in military service members.Objective:To examine white matter integrity associated with PTS and mTBI as assessed using diffusion tensor imaging (DTI).Method:Seventy-four active-duty U.S. soldiers with PTS (n = 16) and PTS with co-morbid history of mTBI (PTS/mTBI; n = 28) were compared to a military control group (n = 30). Participants received a battery of neurocognitive and clinical symptom measures. The number of abnormal DTI values was determined (>2 SDs from the mean of the control group) for fractional anisotropy (FA) and mean diffusivity (MD), and then compared between groups. In addition, mean DTI values from white matter tracts falling into three categories were compared between groups: (i) projection tracts: superior, middle, and inferior cerebellar peduncles, pontine crossing tract, and corticospinal tract; (ii) association tracts: superior longitudinal fasciculus; and (iii) commissure tracts: cingulum bundle (cingulum-cingulate gyrus and cingulum-hippocampus), and corpus callosum.Results:The comorbid PTS/mTBI group had significantly greater traumatic stress, depression, anxiety, and post-concussive symptoms, and they performed worse on neurocognitive testing than those with PTS alone and controls. The groups differed greatly on several clinical variables, but contrary to what we hypothesized, they did not differ greatly on primary and exploratory analytic approaches of hetero-spatial whole brain DTI analyses.Conclusion:The findings suggest that psychological health conditions rather than pathoanatomical changes may be contributing to symptom presentation in this population.

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Severities in persistent mild traumatic brain injury related headache is associated with changes in supraspinal pain modulatory functions

Molecular Pain ◽

10.1177/17448069211037881 ◽

2021 ◽

Vol 17 ◽

pp. 174480692110378

Author(s):

Matthew Flowers ◽

Albert Leung ◽

Dawn M Schiehser ◽

Valerie Metzger-Smith ◽

Lisa Delano-Wood ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Parietal Cortex ◽

Resting State ◽

Premotor Cortex ◽

Sensory Response ◽

Control Group ◽

The Right ◽

Mild Headache

Emerging evidence suggests mild traumatic brain injury related headache (MTBI-HA) is a form of neuropathic pain state. Previous supraspinal mechanistic studies indicate patients with MTBI-HA demonstrate a dissociative state with diminished levels of supraspinal prefrontal pain modulatory functions and enhanced supraspinal sensory response to pain in comparison to healthy controls. However, the relationship between supraspinal pain modulatory functional deficit and severity of MTBI-HA is largely unknown. Understanding this relationship may provide enhanced levels of insight about MTBI-HA and facilitate the development of treatments. This study assessed pain related supraspinal resting states among MTBI-HA patients with various headache intensity phenotypes with comparisons to controls via functional magnetic resonance imaging (fMRI). Resting state fMRI data was analyzed with self-organizing-group-independent-component-analysis in three MTBI-HA intensity groups (mild, moderate, and severe) and one control group (n = 16 per group) within a pre-defined supraspinal pain network based on prior studies. In the mild-headache group, significant increases in supraspinal function were observed in the right premotor cortex (T = 3.53, p < 0.001) and the left premotor cortex (T = 3.99, p < 0.0001) when compared to the control group. In the moderate-headache group, a significant (T = −3.05, p < 0.01) decrease in resting state activity was observed in the left superior parietal cortex when compared to the mild-headache group. In the severe-headache group, significant decreases in resting state supraspinal activities in the right insula (T = −3.46, p < 0.001), right premotor cortex (T = −3.30, p < 0.01), left premotor cortex (T = −3.84, p < 0.001), and left parietal cortex (T = −3.94, p < 0.0001), and an increase in activity in the right secondary somatosensory cortex (T = 4.05, p < 0.0001) were observed when compared to the moderate-headache group. The results of the study suggest that the increase in MTBI-HA severity may be associated with an imbalance in the supraspinal pain network with decline in supraspinal pain modulatory function and enhancement of sensory/pain decoding.

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Assessment of the advantage of the serum S100B protein biomonitoring in the management of paediatric mild traumatic brain injury—PROS100B: protocol of a multicentre unblinded stepped wedge cluster randomised trial

BMJ Open ◽

10.1136/bmjopen-2018-027365 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027365 ◽

Cited By ~ 4

Author(s):

Damien Bouvier ◽

David Balayssac ◽

Julie Durif ◽

Charline Mourgues ◽

Catherine Sarret ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Randomised Trial ◽

S100b Protein ◽

Cluster Randomised Trial ◽

Control Group ◽

Reference Ranges ◽

Stepped Wedge ◽

Serum S100b

IntroductionS100B serum analysis in clinical routine could reduce the number of cranial CT (CCT) scans performed on children with mild traumatic brain injury (mTBI). Sampling should take place within 3 hours of trauma and cut-off levels should be based on paediatric reference ranges. The aim of this study is to evaluate the utility of measuring serum S100B in the management of paediatric mTBI by demonstrating a decrease in the number of CCT scans prescribed in an S100B biomonitoring group compared with a ‘conventional management’ control group, with the assumption of a 30% relative decrease of the number of CCT scans between the two groups.Methods and analysisThe protocol is a randomised, multicentre, unblinded, prospective, interventional study (nine centres) using a stepped wedge cluster design, comparing two groups (S100B biomonitoring and control). Children in the control group will have CCT scans or be hospitalised according to the current recommendations of the French Society of Paediatrics (SFP). In the S100B biomonitoring group, blood sampling to determine serum S100B protein levels will take place within 3 hours after mTBI and subsequent management will depend on the assay. If S100B is in the normal range according to age, the children will be discharged from the emergency department after 6 hours’ observation. If the result is abnormal, CCT scans or hospitalisation will be prescribed in accordance with current SFP recommendations. The primary outcome measure will be the proportion of CCT scans performed (absence/presence of CCT scan for each patient) in the 48 hours following mTBI.Ethics and disseminationThe protocol presented (Version 5, 03 November 2017) has been approved by the ethics committee Comité de Protection des Personnes sud-est 6 (first approval 08 June 2016, IRB: 00008526). Participation in the study is voluntary and anonymous. The study findings will be disseminated in international peer-reviewed journals and presented at relevant conferences.Trial registration numberNCT02819778.

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

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.155 ◽

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.

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Gait Quality Assessment in Survivors from Severe Traumatic Brain Injury: An Instrumented Approach Based on Inertial Sensors

Sensors ◽

10.3390/s19235315 ◽

2019 ◽

Vol 19 (23) ◽

pp. 5315 ◽

Cited By ~ 3

Author(s):

Valeria Belluscio ◽

Elena Bergamini ◽

Marco Tramontano ◽

Amaranta Orejel Bustos ◽

Giulia Allevi ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Inertial Sensors ◽

Gait Disorders ◽

Therapeutic Interventions ◽

Control Group ◽

Walking Ability ◽

Clinical Scales ◽

Gait Quality

Despite existing evidence that gait disorders are a common consequence of severe traumatic brain injury (sTBI), the literature describing gait instability in sTBI survivors is scant. Thus, the present study aims at quantifying gait patterns in sTBI through wearable inertial sensors and investigating the association of sensor-based gait quality indices with the scores of commonly administered clinical scales. Twenty healthy adults (control group, CG) and 20 people who suffered from a sTBI were recruited. The Berg balance scale, community balance and mobility scale, and dynamic gait index (DGI) were administered to sTBI participants, who were further divided into two subgroups, severe and very severe, according to their score in the DGI. Participants performed the 10 m walk, the Figure-of-8 walk, and the Fukuda stepping tests, while wearing five inertial sensors. Significant differences were found among the three groups, discriminating not only between CG and sTBI, but also for walking ability levels. Several indices displayed a significant correlation with clinical scales scores, especially in the 10 m walking and Figure-of-8 walk tests. Results show that the use of wearable sensors allows the obtainment of quantitative information about a patient’s gait disorders and discrimination between different levels of walking abilities, supporting the rehabilitative staff in designing tailored therapeutic interventions.

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Effect of a “T-Band” Kick Training Protocol on Postural Sway

Journal of Sport Rehabilitation ◽

10.1123/jsr.7.2.122 ◽

1998 ◽

Vol 7 (2) ◽

pp. 122-127 ◽

Cited By ~ 4

Author(s):

Andrew G. Baker ◽

William G. Webright ◽

David H. Perrin

Keyword(s):

Postural Sway ◽

Stability Index ◽

Control Group ◽

Eyes Closed ◽

Before And After ◽

Proprioceptive Training ◽

Eyes Open ◽

Potential Benefits ◽

Experimental Group ◽

Training Protocol

The purpose of this study was to examine the effects of a resistive tubing kick training protocol on postural sway in uninjured collegiate wrestlers. An experimental group (n= 10) performed a progressive resistive tubing kick training protocol three times per week for 6 weeks. A control group (n= 9) performed no resistive tubing training during the 6 weeks. Postural sway (stability index) was assessed before and after the 6-week training period. ANOVAs demonstrated no significant interactions, although significant main effects were found for group and eye condition. The experimental group demonstrated less postural sway than the control group regardless of training, and postural sway was greater with the eyes closed than with the eyes open. Resistive tubing kick training does not significantly improve postural sway in healthy collegiate wrestlers. Further research should examine the potential benefits of proprioceptive training using a greater intensity of training and/or using subjects who have a greater potential for improvement.

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