Reference ranges and stability of auditory and vestibular measures in a comprehensive assessment battery for traumatic brain injury

2019 ◽  
pp. 229-241
Author(s):  
Anna Meehan ◽  
◽  
Andrew Lewandowski ◽  
Kayla Deru ◽  
Donald Hebert ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Motor Control ◽  
Brain Injury ◽  
Life Span ◽  
Repeated Measures ◽  
Otoacoustic Emissions ◽  
Pure Tone Audiometry ◽  
Vestibular Evoked Myogenic Potentials ◽  
Reference Ranges ◽  
Brainstem Response

Background: Audiology clinics have many tools available to evaluate auditory and vestibular complaints. However, many tools lack established normative ranges across the life span. We conducted this study to establish reference ranges across the life span for audiology/ vestibular measures commonly used to evaluate patients with traumatic brain injury. Materials and Methods: In this repeated measures study, 75 adults, ages 18-65 years, without a history of traumatic brain injury, underwent robust auditory/vestibular evaluations three times over six months, including rotational chair, videonystagmography, computerized dynamic posturography, vestibular evoked myogenic potentials, and retinal fundoscopy. Results: Age effect was notable for transient evoked otoacoustic emissions, pure-tone audiometry, auditory brainstem response, auditory middle latency response, and auditory-steady state response at 4000 hertz (Hz). Older participants (50-65 years) were more likely to have delayed latency horizontal saccades, positional nystagmus, slowed lower-extremity motor control responses, and delayed latency ocular vestibular evoked myogenic potentials. Low to mid-frequency horizontal (0.003-4 Hz) and mid-frequency vertical (1-3 Hz) vestibulo-ocular reflex, otolith-mediated reflexes, dynamic visual acuity and balance measures were generally not influenced by age. Females had larger static subjective visual testing offset angles, longer cervical vestibular evoked myogenic potential P1 latency, faster velocity horizontal saccades, and quicker motor control latency for large backward translations than age-matched males. Conclusion: These reference ranges can be used to discern impairment within the auditory and vestibular pathway following traumatic brain injury in young to middle-aged adults.

An Electrophysiological Measure of Binaural Hearing in Noise

2008 ◽  
Vol 19 (06) ◽  
pp. 481-495 ◽  
Author(s):  
Jeffrey Weihing ◽  
Frank E. Musiek
Keyword(s):  
Noise Level ◽  
Repeated Measures ◽  
Otoacoustic Emissions ◽  
Pure Tone Audiometry ◽  
Binaural Hearing ◽  
Normal Hearing ◽  
Noise Levels ◽  
Repeated Measures Design ◽  
Brainstem Response ◽  
Different Levels

Background: A common complaint of patients with (central) auditory processing disorder is difficulty understanding speech in noise. Because binaural hearing improves speech understanding in compromised listening situations, quantifying this ability in different levels of noise may yield a measure with high clinical utility. Purpose: To examine binaural enhancement (BE) and binaural interaction (BI) in different levels of noise for the auditory brainstem response (ABR) and middle latency response (MLR) in a normal hearing population. Research Design: An experimental study in which subjects were exposed to a repeated measures design. Study Sample: Fifteen normal hearing female adults served as subjects. Normal hearing was assessed by pure-tone audiometry and otoacoustic emissions. Intervention: All subjects were exposed to 0, 20, and 35 dB effective masking (EM) of white noise during monotic and diotic click stimulation. Data Collection and Analysis: ABR and MLR responses were simultaneously acquired. Peak amplitudes and latencies were recorded and compared across conditions using a repeated measures analysis of variance (ANOVA). Results: For BE, ABR results showed enhancement at 0 and 20 dB EM, but not at 35 dB EM. The MLR showed BE at all noise levels, but the degree of BE decreased with increasing noise level. For BI, both the ABR and MLR showed BI at all noise levels. However, the degree of BI again decreased with increasing noise level for the MLR. Conclusions: The results demonstrate the ability to measure BE simultaneously in the ABR and MLR in up to 20 dB of EM noise and BI in up to 35 dB EM of noise. Results also suggest that ABR neural generators may respond to noise differently than MLR generators.

scholarly journals A Repeated Measures Pilot Comparison of Trajectories of Fluctuating Endogenous Hormones in Young Women with Traumatic Brain Injury, Healthy Controls

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Janet P. Niemeier ◽  
Paul B. Perrin ◽  
Bradley S. Hurst ◽  
David M. Foureau ◽  
Toan T. Huynh ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Young Women ◽  
Repeated Measures ◽  
Endogenous Hormones ◽  
Hospital Emergency ◽  
Serum Samples ◽  
Health History ◽  
Future Work ◽  
Larger Sample

Objective. To compare baseline and 72-hour hormone levels in women with traumatic brain injury (TBI) and controls. Setting. Hospital emergency department. Participants. 21 women ages 18-35 with TBI and 21 controls. Design. Repeated measures. Main Measures. Serum samples at baseline and 72 hours; immunoassays for estradiol (E2), progesterone (PRO), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and cortisol (CORT); and health history. Results. Women with TBI had lower E2 (p=0.042) and higher CORT (p=0.028) levels over time. Lower Glasgow Coma Scale (GSC) and OCs were associated with lower FSH (GCS p=0.021; OCs p=0.016) and higher CORT (GCS p=0.001; OCs p=0.008). Conclusion. Acute TBI may suppress E2 and increase CORT in young women. OCs appeared to independently affect CORT and FSH responses. Future work is needed with a larger sample to characterize TBI effects on women’s endogenous hormone response to injury and OC use’s effects on post-TBI stress response and gonadal function, as well as secondary injury.

Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension

2009 ◽  
Vol 4 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Gad Bar-Joseph ◽  
Yoav Guilburd ◽  
Ada Tamir ◽  
Joseph N. Guilburd
Keyword(s):  
Blood Pressure ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Repeated Measures ◽  
Intervention Group ◽  
Decrease Blood Pressure ◽  
Group 2 ◽  
Group 1

Object Deepening sedation is often needed in patients with intracranial hypertension. All widely used sedative and anesthetic agents (opioids, benzodiazepines, propofol, and barbiturates) decrease blood pressure and may therefore decrease cerebral perfusion pressure (CPP). Ketamine is a potent, safe, rapid-onset anesthetic agent that does not decrease blood pressure. However, ketamine's use in patients with traumatic brain injury and intracranial hypertension is precluded because it is widely stated that it increases intracranial pressure (ICP). Based on anecdotal clinical experience, the authors hypothesized that ketamine does not increase—but may rather decrease—ICP. Methods The authors conducted a prospective, controlled, clinical trial of data obtained in a pediatric intensive care unit of a regional trauma center. All patients were sedated and mechanically ventilated prior to inclusion in the study. Children with sustained, elevated ICP (> 18 mm Hg) resistant to first-tier therapies received a single ketamine dose (1–1.5 mg/kg) either to prevent further ICP increase during a potentially distressing intervention (Group 1) or as an additional measure to lower ICP (Group 2). Hemodynamic, ICP, and CPP values were recorded before ketamine administration, and repeated-measures analysis of variance was used to compare these values with those recorded every minute for 10 minutes following ketamine administration. Results The results of 82 ketamine administrations in 30 patients were analyzed. Overall, following ketamine administration, ICP decreased by 30% (from 25.8 ± 8.4 to 18.0 ± 8.5 mm Hg) (p < 0.001) and CPP increased from 54.4 ± 11.7 to 58.3 ± 13.4 mm Hg (p < 0.005). In Group 1, ICP decreased significantly following ketamine administration and increased by > 2 mm Hg during the distressing intervention in only 1 of 17 events. In Group 2, when ketamine was administered to lower persistent intracranial hypertension, ICP decreased by 33% (from 26.0 ± 9.1 to 17.5 ± 9.1 mm Hg) (p < 0.0001) following ketamine administration. Conclusions In ventilation-treated patients with intracranial hypertension, ketamine effectively decreased ICP and prevented untoward ICP elevations during potentially distressing interventions, without lowering blood pressure and CPP. These results refute the notion that ketamine increases ICP. Ketamine is a safe and effective drug for patients with traumatic brain injury and intracranial hypertension, and it can possibly be used safely in trauma emergency situations.

scholarly journals Hearing Characteristics of Stroke Patients: Prevalence and Characteristics of Hearing Impairment and Auditory Processing Disorders in Stroke Patients

2017 ◽  
Vol 28 (06) ◽  
pp. 491-505 ◽  
Author(s):  
Nehzat Koohi ◽  
Deborah A. Vickers ◽  
Rahul Lakshmanan ◽  
Hoskote Chandrashekar ◽  
David J. Werring ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Hearing Impairment ◽  
Auditory Processing ◽  
Otoacoustic Emissions ◽  
Pure Tone Audiometry ◽  
Stroke Survivors ◽  
Central Auditory Processing ◽  
Hearing Impairments ◽  
Stroke Patients ◽  
Brainstem Response

Background: Stroke survivors may suffer from a range of hearing impairments that may restrict their participation in postacute rehabilitation programs. Hearing impairment may have a significant impact on listening, linguistic skills, and overall communication of the affected stroke patient. However, no studies sought to systematically characterize auditory function of stroke patients in detail, to establish the different types of hearing impairments in this cohort of patients. Such information would be clinically useful in understanding and addressing the hearing needs of stroke survivors. Purpose: The present study aimed to characterize and classify the hearing impairments, using a detailed audiological assessment test battery, in order to determine the level of clinical need and inform appropriate rehabilitation for this patient population. Research Design: A case–control study. Study Sample: Forty-two recruited stroke patients who were discharged from a stroke unit and 40 control participants matched for age. Data Collection and Analysis: All participants underwent pure-tone audiometry and immittance measurements including acoustic reflex threshold, transient-evoked otoacoustic emissions, auditory-evoked brainstem response, and a central auditory processing assessment battery, performed in a single session. Hearing impairments were classified as peripheral hearing loss (cochlear and neural type), central auditory processing disorder (CAPD), and as a combination of CAPD and peripheral hearing loss. Results: Overall mean hearing thresholds were not significantly different between the control and stroke groups. The most common type of hearing impairment in stroke patients was the combination type, “peripheral and CAPD,” in the 61- to 80-yr-old subgroup (in 55%), and auditory processing deficits in 18- to 60-yr-olds (in 40%), which were both significantly higher than in controls. Conclusions: This is the first study to examine hearing function in detail in stroke patients. Given the importance of hearing for the efficiency of communication, it is essential to identify hearing impairments and differentiate peripheral and central deficits to define an appropriate intervention plan.

scholarly journals Translingual Neural Stimulation With the Portable Neuromodulation Stimulator (PoNS®) Induces Structural Changes Leading to Functional Recovery In Patients With Mild-To-Moderate Traumatic Brain Injury

EMJ Radiology ◽  
2020 ◽  
Keyword(s):  
Traumatic Brain Injury ◽  
Motor Control ◽  
Brain Injury ◽  
Physical Therapy ◽  
Visual Motion ◽  
Brain Plasticity ◽  
Automatic Processing ◽  
Neural Stimulation ◽  
Grey Matter Volume ◽  
Moderate Traumatic Brain Injury

Traumatic brain injury (TBI) of varying severity can result in balance and movement disorders, for which the benefits of treatment with physical therapy has limits. In this study, patients with post-TBI balance issues received translingual neural stimulation (TLNS) in concert with physical therapy and the effects on the grey matter volume (GMV) were evaluated. TBI-related balance and movement impairments were also assessed through Sensory Organization Test (SOT) and Dynamic Gait Index (DGI) scoring. When comparing pre- and post-intervention results, the most prominent GMV changes were increases within the cerebellum, and temporal regions, which are involved in automatic processing of gait, balance, motor control, and visual-motion. Decreases of GMV in frontal, occipital lobes (involved in less automatic processing or more conscious/effortful processing of gait, balance, motor control, and vision) positively correlated to increases in SOT/DGI scores. These results indicate that TLNS can produce brain plasticity changes leading to positive changes in functional assessments. Overall, these data indicate that TLNS delivered in conjunction with physical therapy, is a safe, effective, and integrative way to treat TBI.

scholarly journals 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 ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027365 ◽  
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.

CORTICAL INTEGRATIVE THERAPY EFFECTIVENESS IN THE TREATMENT OF POST-CONCUSSION SYNDROME AND MILD TRAUMATIC BRAIN INJURY

2021 ◽  
Vol 57 (2) ◽  
pp. 191-198
Author(s):  
Victor M. Pedro ◽  
◽  
Nicole C. Lim ◽  
Elena Oggero ◽  
◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Treatment Outcomes ◽  
Mild Traumatic Brain Injury ◽  
Repeated Measures ◽  
Postural Stability ◽  
Linear Models ◽  
Retrospective Chart Review ◽  
Integrative Therapy ◽  
Post Concussion Syndrome

Post-Concussion Syndrome (PCS) is a relatively prevalent condition that emerges after sustaining a head injury. Individuals with PCS experience prolonged impairments and distress associated with the injury which can impact the individuals’ quality of life experiences. In this retrospective chart review of refractory adult patients diagnosed with PCS and mild Traumatic Brain Injury (mTBI), the effectiveness of Cortical Integrative Therapy (PedroCIT®) was investigated by comparing measures of postural stability, brain sequencing and timing, and self-reports of physical and psychosocial symptoms of PCS obtained before and after PedroCIT®. Multivariate and Repeated Measures General Linear Models showed improvements across the measures from before to after treatment in all subjects, highlighting the effectiveness of PedroCIT®. To further underscore the capacity of PedroCIT® to elicit improvements in patients who have been resistant to treatment prior to PedroCIT®, the duration of time that the subjects underwent PedroCIT® was compared to the duration of time since the injury to the subjects’ first PedroCIT® intervention session. The findings of this study showed significant improvements from pre- to post-treatment in postural stability, brain sequencing and timing, and self-reported symptoms for patients affected by PCS and mTBI, and treatment outcomes were largely not contingent upon the severity of the condition at the beginning of treatment. Altogether, this retrospective study suggests that refractory individuals affected by PCS and mTBI can benefit from undergoing PedroCIT® and their treatment outcomes may not be related to the degree of impairment presented at the beginning of treatment.

Augmented Feedback for Enhanced Skill Acquisition in Individuals with Traumatic Brain Injury

1996 ◽  
Vol 82 (2) ◽  
pp. 507-514 ◽  
Author(s):  
Ronald Croce ◽  
Michael Horvat ◽  
Glenn Roswal
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Skill Acquisition ◽  
Repeated Measures ◽  
Absolute Constant ◽  
Constant Error ◽  
Augmented Feedback ◽  
Knowledge Of Results ◽  
Variable Error

Coincident timing by individuals who exhibit traumatic brain injury was measured under conditions of no knowledge of results (no KR; n = 12), KR on every trial ( n = 14), summary KR ( n = 13), and average KR ( n = 12). Following acquisition trials, groups performed immediate and longer retention trials without KR. Absolute constant error and variable error, analyzed in separate repeated-measures analyses of variance, indicated that during acquisition trials subjects receiving KR on every trial were the most accurate and the most consistent in their responses; however, subjects in groups receiving summary and average KR were the most accurate during immediate retention, with the group receiving summary KR being the most accurate during longer retention.

The effect of coronavirus disease 2019 on the hearing system

2021 ◽  
pp. 1-5
Author(s):  
Ö Gedik ◽  
H Hüsam ◽  
M Başöz ◽  
N Tas ◽  
F Aksoy
Keyword(s):  
Auditory Brainstem Response ◽  
High Frequency ◽  
Otoacoustic Emissions ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Auditory Brainstem ◽  
Distortion Product ◽  
High Frequency Audiometry ◽  
Brainstem Response ◽  
Hearing System

Abstract Objective This study aimed to evaluate different auditory regions with audiological tests, based on the presumption that there may be damage to the structures in the hearing system after coronavirus disease 2019. Methods Twenty individuals with no history of coronavirus disease 2019 and 27 individuals diagnosed with coronavirus disease 2019 were compared. Pure tone, speech and extended high-frequency audiometry, acoustic immitansmetry, transient evoked and distortion product otoacoustic emissions testing, and auditory brainstem response testing were conducted. Results The pure tone audiometry and extended high-frequency mean threshold values were higher in the coronavirus disease 2019 group. The transient evoked otoacoustic emissions signal-to-noise ratios were bilaterally lower at 4 kHz in individuals with a coronavirus disease 2019 history. In the auditory brainstem response test, only the interpeak latencies of waves III–V were significantly different between groups. Conclusion Coronavirus disease 2019 may cause damage to the hearing system. Patients should be followed up in the long term with advanced audiological evaluation methods in order to determine the extent and level of damage.

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