Upper Limb Motor Improvement after Traumatic Brain Injury: Systematic Review of Interventions

Background Traumatic brain injury (TBI) is a leading cause of adult morbidity and mortality. Individuals with TBI have impairments in both cognitive and motor domains. Motor improvements post-TBI are attributable to adaptive neuroplasticity and motor learning. Majority of the studies focus on remediation of balance and mobility issues. There is limited understanding on the use of interventions for upper limb (UL) motor improvements in this population. Objective We examined the evidence regarding the effectiveness of different interventions to augment UL motor improvement after a TBI. Methods We systematically examined the evidence published in English from 1990–2020. The modified Downs and Black checklist helped assess study quality (total score: 28). Studies were classified as excellent: 24–28, good: 19–23, fair: 14–18, and poor: ≤13 in quality. Effect sizes helped quantify intervention effectiveness. Results Twenty-three studies were retrieved. Study quality was excellent (n = 1), good (n = 5) or fair (n = 17). Interventions used included strategies to decrease muscle tone (n = 6), constraint induced movement therapy (n = 4), virtual reality gaming (n = 5), non-invasive stimulation (n = 3), arm motor ability training (n = 1), stem cell transplant (n = 1), task-oriented training (n = 2), and feedback provision (n = 1). Motor impairment outcomes included Fugl-Meyer Assessment, Modified Ashworth Scale, and kinematic outcomes (error and movement straightness). Activity limitation outcomes included Wolf Motor Function Test and Motor Activity Log (MAL). Effect sizes for majority of the interventions ranged from medium (.5-.79) to large (≥.8). Only ten studies included retention testing. Conclusion There is preliminary evidence that using some interventions may enhance UL motor improvement after a TBI. Answers to emergent questions can help select the most appropriate interventions in this population.

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Upper Limb Motor Improvement after TBI: Systematic Review of Interventions

10.1101/2020.11.12.20214478 ◽

2020 ◽

Author(s):

Sandeep K. Subramanian ◽

Melinda A. Fountain ◽

Ashley F. Hood ◽

Monica Verduzco-Gutierrez

Keyword(s):

Upper Limb ◽

Motor Impairment ◽

Effect Sizes ◽

Cell Transplant ◽

Study Quality ◽

Serial Casting ◽

Wolf Motor Function Test ◽

Activity Performance ◽

Motor Improvement ◽

Task Oriented

AbstractTraumatic Brain Injury (TBI) is a leading cause of adult morbidity and mortality. Individuals sustaining a TBI have impairments in both cognitive and motor domains. Motor improvements post-TBI are attributable to adaptive neuroplasticity and motor learning. Majority of the studies focus on remediation of balance and mobility impairments. There is limited understanding on the use of interventions for upper limb (UL) motor improvements in this population. We examined the evidence regarding the effectiveness of different interventions to augment UL motor improvement after a TBI. We systematically reviewed the literature published in English from 1990-2020. The modified Down’s and Black checklist helped assess study quality (total score:28). Studies were classified as excellent:24-28, good:19-23, fair:14-18 and poor:≤13 in quality. Effect sizes helped quantify intervention effectiveness. Twenty-three studies were retrieved. Study quality was excellent (n=1), good (n=4) or fair (n=19). Interventions used included strategies to decrease spasticity [Botulinum toxin provision (n=2), serial casting, soft splinting, tizanidine and acupuncture (n=1 each)], constraint induced movement therapy (n=4), virtual reality gaming (n=5), noninvasive stimulation (n=3), arm motor ability training (n=1), stem-cell transplant (n=1); task-oriented training (n=2) and augmented feedback (n=1). Motor impairment outcomes included Fugl-Meyer Assessment, Modified Ashworth Scale and kinematic outcomes (error and movement straightness). Activity limitation outcomes included Wolf Motor Function Test and Motor Activity Log. Effect sizes for majority of the interventions ranged from medium (0.5-0.79) to large (≥0.8). Only ten studies included retention testing. Results suggest that using these interventions can reduce UL motor impairment and improve activity performance after a TBI.

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Effectiveness of early abobotulinum toxin (Dysport®) injections in patients with upper limb spastic paresis after traumatic brain injury in real clinical practice: results of a multicenter observational non-interventional prospective study (Adults with post Traumatic Brain Injury (TBI) upper limb (UL) spasticity – APTULS)

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2021-5-48-55 ◽

2021 ◽

Vol 13 (5) ◽

pp. 48-55

Author(s):

S. E. Khatkova ◽

V. P. Diagileva ◽

L. V. Krylova ◽

D. V. Pokhabov ◽

A. G. Arutiunian

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Upper Limb ◽

Large Scale ◽

Brain Injuries ◽

Muscle Tone ◽

Recovery Period ◽

Early Period ◽

Early Recovery ◽

The World

The article reveals results of the first russian prospective observational study, aimed at evaluating of the clinical results early using injections of abobotulinumtoxinA (Abo-BTA, Dysport®) in patients with upper limb spasticity (ULS), which is one of disabling consequence traumatic's brain injuries (TBI). Currently, botulinum therapy is an integral part of the complex treatment of patients with chronic spasticity, has a high level of evidence (level IA), is included in clinical recommendations, national guidelines in a lot of countries around the world countries. The article analyzes results of studies conducted in the world in recent years, which confirm the effectiveness of Abo-BTA injections in the treatment of spasticity, which developing in early period after acute brain injury. Presented data of their own observations are allowed to authors conclude, that using of Abo-BTA injections in the complex rehabilitation of patients with ULS in the early recovery period of TBI demonstrates its good tolerability and a high safety profile, contributes to improving the effectiveness of treatment by reducing muscle tone and spasticity, increasing the volume of movements in joints. Therefore, Abo-BTA injections can be considered as a necessary addition to standard early rehabilitation programs. However, it is necessary to conduct further large-scale studies to more accurately determine the timing of the start of botulinum therapy, the doses of Abo-BTA, the most effective combinations of rehabilitation methods in the creating of individual programs.

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Transcranial Direct Current Stimulation as a Treatment Tool for Mild Traumatic Brain Injury

Brain Sciences ◽

10.3390/brainsci11060806 ◽

2021 ◽

Vol 11 (6) ◽

pp. 806

Author(s):

Thorsten Rudroff ◽

Craig D. Workman

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Therapeutic Potential ◽

Repetitive Transcranial Magnetic Stimulation ◽

Motor Impairment ◽

Direct Current Stimulation ◽

Main Technique

Mild traumatic brain injury (mTBI) has been defined as a transient (<24 h) condition of confusion and/or loss of consciousness for less than 30 min after brain injury and can result in short- and long-term motor and cognitive impairments. Recent studies have documented the therapeutic potential of non-invasive neuromodulation techniques for the enhancement of cognitive and motor function in mTBI. Alongside repetitive transcranial magnetic stimulation (rTMS), the main technique used for this purpose is transcranial direct current stimulation (tDCS). The focus of this review was to provide a detailed, comprehensive (i.e., both cognitive and motor impairment) overview of the literature regarding therapeutic tDCS paradigms after mTBI. A publication search of the PubMed, Scopus, CINAHL, and PsycINFO databases was performed to identify records that applied tDCS in mTBI. The publication search yielded 14,422 records from all of the databases, however, only three met the inclusion criteria and were included in the final review. Based on the review, there is limited evidence of tDCS improving cognitive and motor performance. Surprisingly, there were only three studies that used tDCS in mTBI, which highlights an urgent need for more research to provide additional insights into ideal therapeutic brain targets and optimized stimulation parameters.

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Training Adults with Brain Injury How to Help-seek when Lost: A Pilot Study

Brain Impairment ◽

10.1017/brimp.2015.4 ◽

2015 ◽

Vol 16 (2) ◽

pp. 90-103 ◽

Cited By ~ 1

Author(s):

Young Susan Cho ◽

McKay Moore Sohlberg

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Problem Solving ◽

Communication Skills ◽

Group Intervention ◽

Help Seeking ◽

Preliminary Evidence ◽

Social Problem Solving ◽

Route Finding ◽

Constitutive Factor

There is no research on the assessment or treatment of help-seeking behaviours for individuals with traumatic brain injury (TBI). This paper describes the development of a protocol, NICE (Noticing you have a problem, Identifying the information you need for help, Compensatory strategies, Evaluating progress) to train help-seeking for adults with TBI when lost. Theoretical and treatment components from three empirically validated interventions that target social problem-solving and communication skills were adapted to develop NICE: the Group Interactive Structured Treatment for Social Competence (GIST), the Problem Solving Group Protocol (PSG) and Interpersonal Recall (IPR). Preliminary pilot data evaluating the efficacy are presented for three adult persons with TBI. All three participants improved on the Executive Function Route Finding Task (EFRT) and help-seeking behaviours when wayfinding. Help-seeking is a constitutive factor in the wayfinding process capable of improvement. Preliminary evidence supports further investigation of this group intervention.

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Effect Sizes for Symptomatic and Cognitive Improvements in Traumatic Brain Injury Following Hyperbaric Oxygen Therapy

Journal of Applied Physiology ◽

10.1152/japplphysiol.01084.2020 ◽

2021 ◽

Author(s):

Adam Thomas Biggs ◽

Hugh M. Dainer ◽

Lanny F Littlejohn

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Brain Injuries ◽

Statistical Significance ◽

Traumatic Brain Injuries ◽

Therapeutic Benefit ◽

Effect Sizes

Hyperbaric oxygen therapy has been proposed as a method to treat traumatic brain injuries. The combination of pressure and increased oxygen concentration produces a higher content of dissolved oxygen in the bloodstream, which could generate a therapeutic benefit for brain injuries. This dissolved oxygen penetrates deeper into damaged brain tissue than otherwise possible and promotes healing. The result includes improved cognitive functioning and an alleviation of symptoms. However, randomized controlled trials have failed to produce consistent conclusions across multiple studies. There are numerous explanations that might account for the mixed evidence, although one possibility is that prior evidence focuses primarily on statistical significance. The current analyses explored existing evidence by calculating an effect size from each active treatment group and each control group among previous studies. An effect size measure offers several advantages when comparing across studies as it can be used to directly contrast evidence from different scales, and it provides a proximal measure of clinical significance. When exploring the therapeutic benefit through effect sizes, there was a robust and consistent benefit to individuals who underwent hyperbaric oxygen therapy. Placebo effects from the control condition could account for approximately one-third of the observed benefits, but there appeared to be a clinically significant benefit to using hyperbaric oxygen therapy as a treatment intervention for traumatic brain injuries. This evidence highlights the need for design improvements when exploring interventions for traumatic brain injury as well as the importance of focusing on clinical significance in addition to statistical significance.

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Poster 36 AbobotulinumtoxinA (Dysport® ) in the Treatment of Adult Patients with Upper Limb Spasticity Due to Traumatic Brain Injury

PM&R ◽

10.1016/j.pmrj.2015.06.077 ◽

2015 ◽

Vol 7 ◽

pp. S103-S103 ◽

Cited By ~ 2

Author(s):

Michael W. O'Dell ◽

Heather W. Walker ◽

Steven R. Edgley ◽

Jean-Michel Gracies ◽

Fatma Gul ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Upper Limb ◽

Adult Patients ◽

Limb Spasticity

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Duration of effect of abobotulinumtoxinA (Dysport) in adult patients with upper limb spasticity (ULS) post stroke or traumatic brain injury

Toxicon ◽

10.1016/j.toxicon.2016.11.100 ◽

2016 ◽

Vol 123 ◽

pp. S35 ◽

Cited By ~ 1

Author(s):

Jean-Michel Gracies ◽

Allison Brashear ◽

Christina Marciniak ◽

Robert Jech ◽

Marta Banach ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Upper Limb ◽

Adult Patients ◽

Post Stroke ◽

Duration Of Effect ◽

Limb Spasticity

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Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-324492 ◽

2020 ◽

pp. jnnp-2020-324492

Author(s):

Lindsay Wilson ◽

Lindsay Horton ◽

Kevin Kunzmann ◽

Barbara J Sahakian ◽

Virginia FJ Newcombe ◽

...

Keyword(s):

Mental Health ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Performance ◽

Processing Speed ◽

Daily Life ◽

Short Form ◽

Analysis Of Covariance ◽

Effect Sizes ◽

Different Levels

ObjectiveCognitive impairment is a key cause of disability after traumatic brain injury (TBI) but relationships with overall functioning in daily life are often modest. The aim is to examine cognition at different levels of function and identify domains associated with disability.Methods1554 patients with mild-to-severe TBI were assessed at 6 months post injury on the Glasgow Outcome Scale—Extended (GOSE), the Short Form-12v2 and a battery of cognitive tests. Outcomes across GOSE categories were compared using analysis of covariance adjusting for age, sex and education.ResultsOverall effect sizes were small to medium, and greatest for tests involving processing speed (ηp2 0.057–0.067) and learning and memory (ηp2 0.048–0.052). Deficits in cognitive performance were particularly evident in patients who were dependent (GOSE 3 or 4) or who were unable to participate in one or more major life activities (GOSE 5). At higher levels of function (GOSE 6–8), cognitive performance was surprisingly similar across categories. There were decreases in performance even in patients reporting complete recovery without significant symptoms. Medium to large effect sizes were present for summary measures of cognition (ηp2 0.111), mental health (ηp2 0.131) and physical health (ηp2 0.252).ConclusionsThis large-scale study provides novel insights into cognitive performance at different levels of disability and highlights the importance of processing speed in function in daily life. At upper levels of outcome, any influence of cognition on overall function is markedly attenuated and differences in mental health are salient.

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Methodological Issues in Longitudinal Research on Cognitive Recovery after Traumatic Brain Injury: Evidence from a Systematic Review

Brain Impairment ◽

10.1017/brimp.2013.24 ◽

2013 ◽

Vol 14 (3) ◽

pp. 450-474 ◽

Cited By ~ 10

Author(s):

Regina Schultz ◽

Robyn L. Tate

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Longitudinal Research ◽

Effect Sizes ◽

Methodological Issues ◽

Post Injury ◽

Cognitive Recovery ◽

Cognitive Domains ◽

Severe Tbi

Background: Previous research addressing cognitive recovery after traumatic brain injury (TBI) in adults has predominately used cross-sectional methods. This systematic review examines longitudinal research into cognitive recovery in the first 2 years following moderate-to-severe TBI in adults and aims to identify apparent methodological issues with the existing literature.Design: Systematic review of the first 2 years post-trauma.Setting: Data were extracted from three electronic databases and manual searches of published articles until October 2012.Participants: Two hundred and forty-two participants with severe TBI and 281 comparison participants were used to calculate effect sizes.Results: Twenty papers met the selection criteria, with effect sizes computed from four studies. Moderate-to-large effect sizes were initially observed between the TBI and comparison groups on most measures (range: d = 0.2–2.8). Recovery continued in all five cognitive domains over the 2 years post-injury.Conclusions: Results demonstrated that cognitive recovery was continuous throughout the first 2 years following moderate-to-severe TBI. Findings also indicated different rates of recovery for the specific cognitive domains, highlighting the heterogeneous nature of cognitive recovery after TBI. The review highlighted several methodological issues within the limited existing literature; recommendations were developed to improve the evidence base.

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