A Patient-guided Measure of Functional Status Following Traumatic Brain Injury: The Bob Brown Scale

2020 ◽  
Author(s):  
Nancy Ann Carney ◽  
Molly Stillwell ◽  
Hugo du Coudray
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Status ◽  
Support Groups ◽  
Subjective Experience ◽  
Economic Status ◽  
Reliability And Validity ◽  
Future Research ◽  
Significant Difference ◽  
Patient Responses

Abstract Background: While technology for treating traumatic brain injury (TBI) continues to improve, unexplained variation in outcomes persists. A growing body of literature provides evidence for the influence of subjective experience on objective physiological processes. We worked with TBI survivors and their family/caregivers to develop a model of recovery that incorporates patients’ subjective experience with objective measures of functional status (FS) to investigate factors that foster recovery. We then developed a measure of FS that reflects the priorities and perspectives of the patient population. The purpose of this report is to present our process for establishing the reliability and validity of the FS measure.Methods: Through an iterative process we elicited from TBI survivors their priorities for evaluation and measurement of FS. We assembled their responses into an 18-item measure and administered the pilot survey to 68 people with TBI from support groups in Oregon. Final administration was a survey mailed to 837 TBI survivors. Reliability analyses were conducted to evaluate internal consistency. A Cronbach’s Alpha was calculated for each sub-construct of the scale. A Difficulty Function was calculated to compare patient responses to family responses within each construct. Content validity analysis was conducted comparing constructs and items from the measure to those of 11 established, validated TBI outcome measures. an Analysis of Variance (ANOVA) was conducted to investigate the relationship between survivors’ FS scores and their post-trauma socio-economic status.Results: There were 248 complete cases in the sample. Reliability analysis provided adequate inter-item correlations. Difficulty functions ranged from .69 to .47. Construct validity was established with 11 validated instruments used to evaluate TBI. The ANOVA revealed a significant difference between FS scores and post-trauma SES; survivors with lower FS scores experienced lower post-trauma SES.Conclusions: Our goal was to develop a measure of functional status following TBI using the advice and assistance of survivors of TBI and their families. In this paper we present our process for developing and assessing the reliability and validity of the Functional Status measure of the Bob Brown Scale. Future research will be use of the BBS in a prospective sample of TBI survivors.

scholarly journals GERIATRIC TRAUMATIC BRAIN INJURY AND ALZHEIMER’S DISEASE SHARE SIMILAR PATTERNS OF WHITE MATTER DEGRADATION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S96-S96
Author(s):  
Andrei Irimia ◽  
Kenneth Rostowsky ◽  
Nikhil Chaudhari ◽  
Maria Calvillo ◽  
Sean Lee
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Corpus Callosum ◽  
Diffusion Tensor ◽  
Future Research ◽  
Post Injury ◽  
Significant Difference

Abstract Although mild traumatic brain injury (mTBI) and Alzheimer’s disease (AD) are associated with white matter (WM) degradation, the nature of these alterations and the outcomes of their comparison have not been elucidated. Diffusion tensor imaging (DTI) has been utilized in both conditions, and has uncovered decreases in the fractional anisotropy (FA) of the corpus callosum and cingulum bundle, compared to healthy control (HC) volunteers [1, 2]. Despite mTBI being a potential risk factor for AD, no systematic quantitative comparison has been drawn between their WM degradation patterns. Here we investigated WM FA differences using DTI and tract-based spatial statistics (TBSS) between age- and sex-matched adults: 33 chronic mTBI patients, 67 AD patients and 81 HC participants. T1-weighted magnetic resonance imaging (MRI) and DTI were acquired at 3T. mTBI patients were scanned acutely and ~6 months post-injury. FSL software was used for artefact correction, FA computation and TBSS implementation. Statistical comparison of WM FA patterns between mTBI and AD patients was achieved by two one-sided t tests (TOSTs) of statistical equivalence, with equivalence bounds defined where Cohen’s d < 0.3. A significant difference was found between the FA means of mTBI vs. HC groups, and the AD vs. HC groups (p < 0.01, corrected). Mean FA differences between mTBI and AD were statistically equivalent in the corpus callosum and in the inferior longitudinal fasciculus (p < 0.05, corrected). Future research should focus on clarifying the similarities between mTBI and AD, potentially leading to novel hypotheses and improved AD diagnosis.

Using the La Trobe Communication Questionnaire to Measure Perceived Social Communication Ability in Adolescents With Traumatic Brain Injury

2010 ◽  
Vol 11 (2) ◽  
pp. 171-182 ◽  
Author(s):  
Jacinta M. Douglas
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Social Communication ◽  
Economic Status ◽  
Reliability And Validity ◽  
Control Group ◽  
Clinical Tool ◽  
Moving Vehicle ◽  
Communication Ability ◽  
Close Relatives

AbstractIntroduction:The La Trobe Communication Questionnaire (LCQ) was developed to measure perceived social communication ability from various sources including the self-perceptions of individuals as well as those of others with whom they converse regularly (e.g., family members, friends and clinicians). It has been psychometrically evaluated with healthy young adults and adults with traumatic brain injury (TBI) and found to have acceptable reliability and validity. The present study was conducted to gauge the ability of the LCQ to distinguish between a group of adolescents who had sustained TBI and a control group of neurologically normal adolescents matched on the variables of socio-economic status (SES), age, gender and level of education completed.Method:Participants were 19 TBI dyads (TBI adolescents and close relatives) and 19 control dyads. All TBI adolescents had sustained severe injury (mean posttraumatic amnesia duration 33.76 days,SD18.13) due to moving vehicle-related trauma. Mean age at the time of injury was 16.33 years (SD 1.67) and at the time of assessment 17.11years (SD1.90). The LCQ was administered to all participants at home.Results:Perceptions of TBI adolescents and their relatives were significantly different from those of control dyads and consistent with a higher frequency of social communication difficulties in the TBI group. Difficulties reflected reduced conversational fluency and problems with managing the multiple demands of social discourse.Conclusions:The LCQ is a clinical tool that has sound potential to contribute to the multifaceted assessment of social communication in adolescents with TBI.

Challenges and Opportunities for Neuroimaging in Young Patients with Traumatic Brain Injury: a Coordinated Effort towards Advancing Discovery from the ENIGMA Pediatric Moderate/Severe TBI Group

2019 ◽  
Author(s):  
Emily L. Dennis ◽  
Karen Caeyenberghs ◽  
Robert F. Asarnow ◽  
Talin Babikian ◽  
Brenda Bartnik-Olson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Young Patients ◽  
Future Research ◽  
Childhood And Adolescence ◽  
Developmental Issues ◽  
Challenges And Opportunities ◽  
Severe Tbi ◽  
Advance Research

Traumatic brain injury (TBI) is a major cause of death and disability in children in both developed and developing nations. Children and adolescents suffer from TBI at a higher rate than the general population; however, research in this population lags behind research in adults. This may be due, in part, to the smaller number of investigators engaged in research with this population and may also be related to changes in safety laws and clinical practice that have altered length of hospital stays, treatment, and access to this population. Specific developmental issues also warrant attention in studies of children, and the ever-changing context of childhood and adolescence may require larger sample sizes than are commonly available to adequately address remaining questions related to TBI. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric Moderate-Severe TBI (msTBI) group aims to advance research in this area through global collaborative meta-analysis. In this paper we discuss important challenges in pediatric TBI research and opportunities that we believe the ENIGMA Pediatric msTBI group can provide to address them. We conclude with recommendations for future research in this field of study.

scholarly journals Age, Sex and Cerebral Microbleed Effects On White Matter Degradation After Traumatic Brain Injury

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 886-887
Author(s):  
Andrei Irimia ◽  
Ammar Dharani ◽  
Van Ngo ◽  
David Robles ◽  
Kenneth Rostowsky
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Diffusion Tensor ◽  
Diffuse Axonal Injury ◽  
Principal Component ◽  
Older Age ◽  
Analysis Of Covariance ◽  
Future Research ◽  
Cerebral Microbleed

Abstract Mild traumatic brain injury (mTBI) affects white matter (WM) integrity and accelerates neurodegeneration. This study assesses the effects of age, sex, and cerebral microbleed (CMB) load as predictors of WM integrity in 70 subjects aged 18-77 imaged acutely and ~6 months after mTBI using diffusion tensor imaging (DTI). Two-tensor unscented Kalman tractography was used to segment and cluster 73 WM structures and to map changes in their mean fractional anisotropy (FA), a surrogate measure of WM integrity. Dimensionality reduction of mean FA feature vectors was implemented using principal component (PC) analysis, and two prominent PCs were used as responses in a multivariate analysis of covariance. Acutely and chronically, older age was significantly associated with lower FA (F2,65 = 8.7, p < .001, η2 = 0.2; F2,65 = 12.3, p < .001, η2 = 0.3, respectively), notably in the corpus callosum and in dorsolateral temporal structures, confirming older adults’ WM vulnerability to mTBI. Chronically, sex was associated with mean FA (F2,65 = 5.0, p = 0.01, η2 = 0.1), indicating males’ greater susceptibility to WM degradation. Acutely, a significant association was observed between CMB load and mean FA (F2,65 = 5.1, p = 0.009, η2 = 0.1), suggesting that CMBs reflect the acute severity of diffuse axonal injury. Together, these findings indicate that older age, male sex, and CMB load are risk factors for WM degeneration. Future research should examine how sex- and age-mediated WM degradation lead to cognitive decline and connectome degeneration after mTBI.

scholarly journals Creatine Supplementation and Brain Health

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 586 ◽  
Author(s):  
Hamilton Roschel ◽  
Bruno Gualano ◽  
Sergej M. Ostojic ◽  
Eric S. Rawson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cognitive Function ◽  
Cognitive Processing ◽  
Brain Function ◽  
Creatine Supplementation ◽  
Short Review ◽  
Future Research ◽  
Brain Health

There is a robust and compelling body of evidence supporting the ergogenic and therapeutic role of creatine supplementation in muscle. Beyond these well-described effects and mechanisms, there is literature to suggest that creatine may also be beneficial to brain health (e.g., cognitive processing, brain function, and recovery from trauma). This is a growing field of research, and the purpose of this short review is to provide an update on the effects of creatine supplementation on brain health in humans. There is a potential for creatine supplementation to improve cognitive processing, especially in conditions characterized by brain creatine deficits, which could be induced by acute stressors (e.g., exercise, sleep deprivation) or chronic, pathologic conditions (e.g., creatine synthesis enzyme deficiencies, mild traumatic brain injury, aging, Alzheimer’s disease, depression). Despite this, the optimal creatine protocol able to increase brain creatine levels is still to be determined. Similarly, supplementation studies concomitantly assessing brain creatine and cognitive function are needed. Collectively, data available are promising and future research in the area is warranted.

scholarly journals Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jia-cheng Gu ◽  
Hong Wu ◽  
Xing-zhao Chen ◽  
Jun-feng Feng ◽  
Guo-yi Gao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
External Ventricular Drainage ◽  
Unfavorable Outcome ◽  
Ventricular Drainage ◽  
Outcome Group ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

scholarly journals Serum S100B Determination in the Management of Pediatric Mild Traumatic Brain Injury

2012 ◽  
Vol 58 (7) ◽  
pp. 1116-1122 ◽  
Author(s):  
Damien Bouvier ◽  
Mathilde Fournier ◽  
Jean-Benoît Dauphin ◽  
Flore Amat ◽  
Sylvie Ughetto ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Reference Interval ◽  
Pediatric Emergency ◽  
Cranial Computed Tomography ◽  
Serum S100b ◽  
Significant Difference ◽  
Hospitalization Costs ◽  
Group 2

Abstract BACKGROUND The place of serum S100B measurement in mild traumatic brain injury (mTBI) management is still controversial. Our prospective study aimed to evaluate its utility in the largest child cohort described to date. METHODS Children younger than 16 years presenting at a pediatric emergency department within 3 h after TBI were enrolled prospectively for blood sampling to determine serum S100B concentrations. The following information was collected: TBI severity determined by using the Masters classification [1: minimal or Glasgow Coma Scale (GCS) 15, 2: mild or GCS 13–15, and 3: severe or GCS <13]; whether hospitalized or not; good or bad clinical evolution (CE); whether cranial computed tomography (CCT) was prescribed; and related presence (CCT+) or absence (CCT−) of lesions. RESULTS For the 446 children enrolled, the median concentrations of S100B were 0.21, 0.31, and 0.44 μg/L in Masters groups 1, 2, and 3, respectively, with a statistically significant difference between these groups (P < 0.05). In Masters group 2, 65 CCT scans were carried out. Measurement of S100B identified patients as CCT+ with 100% (95% CI 85–100) sensitivity and 33% (95% CI 20–50) specificity. Of the 424 children scored Masters 1 or 2, 21 presented “bad CE.” S100B identified bad CE patients with 100% (95% CI 84–100) sensitivity and 36% (95% CI 31–41) specificity. Of the 242 children hospitalized, 81 presented an S100B concentration within the reference interval. CONCLUSIONS Serum S100B determination during the first 3 h of management of children with mTBI has the potential to reduce the number of CCT scans, thereby avoiding unnecessary irradiation, and to save hospitalization costs.

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