Onabotulinum Toxin A for the Treatment of Headache in Service Members With a History of Mild Traumatic Brain Injury: A Cohort Study

Abstract Background Service members with a history of mild traumatic brain injury (mTBI) frequently report problems paying attention. In combat and training settings, visual attention is critical given the demand to warfighter performance. Many computerized cognitive rehabilitation programs exist, however the impact of their effectiveness on improving visual attention is unknown. Methods A randomized controlled trial consisted of 22 active-duty service members with a history of mTBI. Participants were randomized to Lumosity (N = 8) which focused on multiple cognitive domains or UCR which has a specific focus on visual attention (N = 14). Cognitive assessment was completed at baseline and following treatment. The Neuropsychological Assessment Battery (NAB) Driving Scenes subtest was used as the primary assessment of visual attention. All participants passed a validity measure pre and post assessment. Results A one-way ANOVA revealed that performance on NAB Driving Scenes improved for all participants after treatment (F = 4.18, p = 0.046); however, when computer program type was analyzed there was no interaction (F = 0.32, p = 0.860). Participants who completed the UCR intervention improved from M = 41.64, SD = 11.58 to M = 46.79, SD = 14.52, Cohen’s d = 0.43. For the Lumosity condition, there was a medium effect size (Cohen’s d = 0.46) from baseline (M = 38.63, SD = 14.33) to post treatment (M = 44.75, SD = 9.47) Conclusions The results indicated that both programs proved effective at improving visual attention symptoms. These findings provide support for the use of computerized cognitive rehabilitation programs as a form of intervention for mTBI.

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Performance Validity, Neurocognitive Disorder, and Post-concussion Symptom Reporting in Service Members with a History of Mild Traumatic Brain Injury

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acx098 ◽

2017 ◽

Vol 33 (5) ◽

pp. 606-618 ◽

Cited By ~ 6

Author(s):

Sara M Lippa ◽

Rael T Lange ◽

Louis M French ◽

Grant L Iverson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Symptom Reporting ◽

Service Members ◽

Neurocognitive Disorder ◽

Performance Validity ◽

History Of

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Assessment of Cognitive-Communicative Disorders of Mild Traumatic Brain Injury Sustained in Combat

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld19.2.47 ◽

2009 ◽

Vol 19 (2) ◽

pp. 47-57 ◽

Cited By ~ 10

Author(s):

Christine Parrish ◽

Carole Roth ◽

Brooke Roberts ◽

Gail Davie

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Psychological Health ◽

Communication Disorders ◽

Service Members ◽

Patient Questionnaire ◽

Speech Language Pathologists ◽

Test Protocol ◽

Communication Deficits

Abstract Background: Mild traumatic brain injury (mTBI) is recognized as the signature injury of the current conflicts in Iraq and Afghanistan, yet there remains limited understanding of the persisting cognitive deficits of mTBI sustained in combat. Speech-language pathologists (SLPs) have traditionally been responsible for evaluating and treating the cognitive-communication disorders following severe brain injuries. The evaluation instruments historically used are insensitive to the subtle deficits found in individuals with mTBI. Objectives: Based on the limited literature and clinical evidence describing traditional and current tests for measuring cognitive-communication deficits (CCD) of TBI, the strengths and weaknesses of the instruments are discussed relative to their use with mTBI. It is necessary to understand the nature and severity of CCD associated with mTBI for treatment planning and goal setting. Yet, the complexity of mTBI sustained in combat, which often co-occurs with PTSD and other psychological health and physiological issues, creates a clinical challenge for speech-language pathologists worldwide. The purpose of the paper is to explore methods for substantiating the nature and severity of CCD described by service members returning from combat. Methods: To better understand the nature of the functional cognitive-communication deficits described by service members returning from combat, a patient questionnaire and a test protocol were designed and administered to over 200 patients. Preliminary impressions are described addressing the nature of the deficits and the challenges faced in differentiating the etiologies of the CCD. Conclusions: Speech-language pathologists are challenged with evaluating, diagnosing, and treating the cognitive-communication deficits of mTBI resulting from combat-related injuries. Assessments that are sensitive to the functional deficits of mTBI are recommended. An interdisciplinary rehabilitation model is essential for differentially diagnosing the consequences of mTBI, PTSD, and other psychological and physical health concerns.

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Improving the Lives of Service Members and Veterans With Mild Traumatic Brain Injury and Their Families: Matching Interventions to Needs

PsycEXTRA Dataset ◽

10.1037/e662582011-001 ◽

2011 ◽

Author(s):

Ann Landes

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Service Members

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Eyeball Pressure Stimulation Unveils Subtle Autonomic Cardiovascular Dysfunction in Persons with a History of Mild Traumatic Brain Injury

Journal of Neurotrauma ◽

10.1089/neu.2014.3842 ◽

2015 ◽

Vol 32 (22) ◽

pp. 1796-1804 ◽

Cited By ~ 13

Author(s):

Max J. Hilz ◽

Felix Aurnhammer ◽

Steven R. Flanagan ◽

Tassanai Intravooth ◽

Ruihao Wang ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Cardiovascular Dysfunction ◽

History Of

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Blood Biomarkers Relate to Cognitive Performance Years after Traumatic Brain Injury in Service Members and Veterans

Journal of the International Neuropsychological Society ◽

10.1017/s1355617720001071 ◽

2020 ◽

pp. 1-7

Author(s):

Sara M. Lippa ◽

Jessica Gill ◽

Tracey A. Brickell ◽

Louis M. French ◽

Rael T. Lange

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Outcome ◽

Service Members ◽

Neurocognitive Performance ◽

Blood Biomarkers ◽

Post Injury ◽

Blood Draw ◽

Neurofilament Light ◽

History Of

Abstract Objective: This study examines the relationship of serum total tau, neurofilament light (NFL), ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) with neurocognitive performance in service members and veterans with a history of traumatic brain injury (TBI). Method: Service members (n = 488) with a history of uncomplicated mild (n = 172), complicated mild, moderate, severe, or penetrating TBI (sTBI; n = 126), injured controls (n = 116), and non-injured controls (n = 74) prospectively enrolled from Military Treatment Facilities. Participants completed a blood draw and neuropsychological assessment a year or more post-injury. Six neuropsychological composite scores and presence/absence of mild neurocognitive disorder (MNCD) were evaluated. Within each group, stepwise hierarchical regression models were conducted. Results: Within the sTBI group, increased serum UCH-L1 was related to worse immediate memory and delayed memory (R2Δ = .065–.084, ps < .05) performance, while increased GFAP was related to worse perceptual reasoning (R2Δ = .030, p = .036). Unexpectedly, within injured controls, UCH-L1 and GFAP were inversely related to working memory (R2Δ = .052–.071, ps < .05), and NFL was related to executive functioning (R2Δ = .039, p = .021) and MNCD (Exp(B) = 1.119, p = .029). Conclusions: Results suggest GFAP and UCH-L1 could play a role in predicting poor cognitive outcome following complicated mild and more severe TBI. Further investigation of blood biomarkers and cognition is warranted.

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